Oncology & Hematology Coding Alert

Question: What is the correct way to code for radium Ra 223 (Xofigo) therapy for a patient with advanced resistant prostate cancer?

Texas Participant

Answer: How you code this will depend on what your oncologist actually does in the therapy and whether your practice supplies the Xofigo used. Follow these steps to arrive at the most appropriate way to document what your practice has — or not has not — done for the patient in this prostate cancer treatment service.

Step 1: Code for planned follow-up or not. The basic regimen for Xofigo involves administration of six injections of the radiopharmaceutical, usually at four-week intervals. If your provider determines that your patient will need follow-up care for the treatment, you will use 77750 (Infusion or instillation of radioelement solution (includes 3-month follow-up care)). But if your provider decides the patient will not need follow-up, then you will use 79101 (Radiopharmaceutical therapy, by intravenous administration). This code is inclusive of any unplanned follow-up the patient may need during the 90-day global period for the therapy.

Step 2: Modify for the technical or professional component. The coding does not stop at the CPT^® code that describes the follow-up involved in the service. If your oncologist is only reporting the professional component of the service, such as the initial consultation, dosimetry, and follow-up care (whether planned or not), you will append modifier 26 (Professional component) to the chosen CPT^® code. And if your office is only supplying the technical components of the treatment, such as the treatment devices and administration, you will append modifier TC (Technical component). No modifier is necessary for either code if your oncologist provides both components.

Step 3: Then code for medication as appropriate. If you provide the radiopharmaceutical, you will also bill for it using A9606 (Radium Ra-223 dichloride, therapeutic, per microcurie). The number of units will be calculated based on a dosage of 55 kBq (1.49 microcurie) per kg body weight. So, for a patient weighing 72 kg (159 lb.), you will bill 107.28 units of Xofigo.