Oncology & Hematology Coding Alert

Question: How should I code Sandostatin IM injections? I thought the correct code was 90722, but the nurses I work with want to code this as a chemo injection (96401-96417) when giving it for a cancer diagnosis.


Maryland Subscriber 


Answer: The correct code is 90772 (Therapeutic, prophylactic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) for a Sandostatin injection. Even though oncologists sometimes use the drug to treat neoplasms, Sandostatin (octreotide acetate) is not actually an antineoplastic agent--so the chemotherapy codes would not be appropriate.

Check with your payers for their coverage limits and acceptable diagnoses. According to Novartis, the maker of Sandostatin, ICD-9 codes that may show medical necessity for the drug include:

- 157.4--Malignant neoplasm of pancreas; islets of Langerhans

- 211.7--Benign neoplasm of other parts of the digestive system; islets of Langerhans
- 253.0--Acromegaly and gigantism
- 259.2--Other endocrine disorders; carcinoid   syndrome.

Don't miss: For the supply of the drug, report HCPCS code J2353 (Injection, octreotide, depot form for intramuscular injection, 1 mg) for Sandostatin LAR or J2354 (Injection, octreotide, nondepot form for subcutaneous or intravenous injection, 25 mcg) for the immediate-release form.