Oncology & Hematology Coding Alert

Question: How should I report the following chemotherapy encounter for a patient with Ewing's sarcoma of the femur?

• 2mg, vincristine, IV, 5 minutes
• 1.81 mg, dactinomycin, IV push
• 1668 mg, cyclophosphamide, IV, 1 hour
• 333.6 mg, mesna mixed in same bag as cyclophosphamide

Texas Subscriber

Answer: Ewing's sarcoma is a rare bone cancer that is most likely to affect children and young adults. For a femur sarcoma, you should report 170.7 (Malignant neoplasm of long bones of lower limb). Remember to report V58.11 (Encounter for antineoplastic chemotherapy) first if the main purpose of the encounter is chemotherapy. The corresponding ICD-10-CM codes are C40.2- (Malignant neoplasm of long bones of ... lower limb) and Z51.11 (Encounter for antineoplastic chemotherapy). Note that the fifth character of the neoplasm code will vary based on whether the leg is unspecified (0), right (1), or left (2).

For the administration, begin with the mixture of cyclophosphamide and mesna in the same bag. Cyclophosphamide interferes with the growth of cancer cells. Report 17 units of J9070 (Cyclophosphamide, 100 mg) for the 1668 mg administered. Mesna is a cell-protecting agent typically used to prevent damage to the bladder and kidneys. The code for mesna is J9209 (Injection, mesna, 200 mg). You should report 2 units for the 333.6 mg administered.

Because the two are mixed in the same bag, you should report a single code for this one hour infusion: 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug).

Next you have two chemotherapy pushes to report, each coded using +96411 (Chemotherapy administration; intravenous, push technique, each additional substance/drug [List separately in addition to code for primary procedure]). You should report a quantity of 2 for +96411.

For the vincristine, you should report 2 units of J9370 (Vincristine sulfate, 1 mg). Finally, report 4 units of J9120 (Injection, dactinomycin, 0.5 mg).