CORE Home | Health Care Professionals | Coding Information | TREANDA® Billing Codes   Coding Guide | TREANDA® for IV Infusion   Most third-party payers, including Medicare, state Medicaid plans, managed care organizations, indemnity plans and others, provide coverage for TREANDA. In the Physician Office Setting Claims Submission Physicians submit a CMS-1500 (08-05) claim form or its electronic equivalent for TREANDA to the appropriate Medicare Administrative Contractor (MAC), Carrier or non-Medicare payer. Physicians report various codes on the claim form to indicate the medical necessity for TREANDA and its administration in order to receive proper payment from payers. Place of Service Place of Service (POS) 11 indicates the services were provided in an office. POS is reported in Item 24B Place of Service on the CMS-1500 claim form. Diagnosis Code(s) All payers recognize International Classification of Drugs, 9th Revision, Clinical Modification (ICD-9-CM) diagnosis codes to indicate the medical necessity for TREANDA. Payers may delay processing, deny, or reject claims without valid diagnoses, requiring the physician to complete and resubmit a corrected claim. The physician must list an appropriate diagnosis code for TREANDA in Item 21 Diagnosis or Nature of Illness or Injury of the CMS-1500 claim form and then link the diagnosis to Item 24E Diagnosis Pointer of the corresponding line. TREANDA for Injection is indicated for the treatment of patients with: Chronic lymphocytic leukemia (CLL). Efficacy relative to first line therapies other than chlorambucil has not been established. ndolent B-cell non-Hodgkin's lymphoma (NHL) that has progressed during or within six months of treatment with rituximab or a rituximab-containing regimen. The following serious adverse reactions have been associated with TREANDA in clinical trials: myelosuppression, infections, infusion reactions and anaphylaxis, tumor lysis syndrome, skin reactions, and other malignancies. ICD-9-CM Code (Non-Hodgkin's Lymphoma) CMS-1500 Location 200.10-200.18 Lymphosarcoma Item 21 and 24E 200.30-200.38 Marginal Zone lymphoma 202.00-202.08 Nodular lymphoma ICD-9-CM Code (Chronic Lymphocytic Leukemia) CMS-1500 Location 204.10 Lymphoid leukemia, chronic, without mention of remission Item 21 and 24E 204.11 Lymphoid leukemia, chronic, in remission 204.12 Lymphoid leukemia, chronic, in relapse (effective 10/1/08) ICD-9-CM Code (Encounter for Chemotherapy) CMS-1500 Location V58.11 Encounter for chemotherapy Item 21 and 24E The fifth digit identifies further specificity regarding location: 0 = unspecified site, extranodal and solid organ sites, 1 = lymph nodes of head, face, and neck, 2 = intrathoracic lymph nodes, 3 = intra-abdominal lymph nodes, 4 = lymph nodes of axilla and upper limb, 5 = lymph nodes of inguinal region and lower limb, 6 = intrapelvic lymph nodes, 7 = spleen, 8 = lymph nodes of multiple sites   The primary diagnosis for CLL is reported with an ICD-9-CM code in the 204.10 – 204.12 range. For NHL, an ICD-9-CM code in the 200 or 202 series is listed as the primary diagnosis. Depending on your MAC, Carrier or other payer, ICD-9-CM code V58.11 may be required as a secondary diagnosis code when TREANDA is administered at the encounter for chemotherapy. TREANDA Drug Code Healthcare Common Procedure Coding System (HCPCS) Level 2 codes are used to report drugs. TREANDA is reported with a specific HCPCS code, J9033, in item 24D Procedures, Services or Supplies CPT/HCPCS of the CMS 1500 claim form. HCPCS CMS-1500 Location J9033 Bendamustine HCl, 1mg Item 24D   HCPCS J9033 has a specific value of 1mg that represents a part of a TREANDA vial. Providers must report multiple units on the claim form to report an entire vial of TREANDA. For example, usage of a 100mg Single Use Vial (SUV) of TREANDA is reported with 100 units in Item 24G Days or Units. It is important to report on the CMS-1500 all of the drug that was used including the total amount of TREANDA administered and discarded since most payers will reimburse for the amount of drug administered and wasted. The medical record documentation should include: Number of single use vials of TREANDA purchased Amount of drug administered Amount of drug discarded Reason why it was discarded, e.g., partial drug from an SUV was required TREANDA Administration Code Healthcare Common Procedure Coding System (HCPCS) Level 1 codes, more commonly known as Current Procedural Terminology (CPT) codes are used to report the administration of TREANDA. Based on the FDA approved method of administration for TREANDA, the physician must list an appropriate CPT code for the Intravenous (IV) infusion in Item 24D or Supplies of the CMS-1500 claim form. CPT Administration Codes CMS-1500 Location 96413 Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug Item 24D 96415 Chemotherapy administration, intravenous infusion technique; each additional hour 96417 Each additional sequential infusion (different substance/drug), up to 1 hour (list separately in addition to code for primary procedure)   Per prescribing information, TREANDA is administered via a 30 or 60-minute IV infusion depending on the indication. Per CPT code guidelines, an IV infusion lasting greater than 15 minutes and up to 90 minutes is reported with one unit (Item 24E) of CPT code 96413 (Item 24D). Medical justification for IV infusion times for TREANDA should be clearly documented in the medical record with start and stop times. TREANDA Reimbursement Expertise – TREANDA Reimbursement Expertise is a reimbursement resource for healthcare providers and patients. It provides a support program, and online tools and resources to help make it easier to understand reimbursement information. You can get information on the website www.CephalonOncologyCore.com, or call the Hotline toll-free at 1-888-5-TREANDA (1-888-587-3263). The program provides personalized support with the following: Billing issues Insurance policy benefits Coverage requirements Appeals of coverage denials This guide is provided for informational purposes only and is not intended to be an all inclusive list. You are responsible for the accuracy of any claims, invoices, and related documentation submitted to payers. Please contact the payer and consult source documents to verify codes and billing requirements. Cephalon Oncology does not guarantee success in obtaining insurance payments. In the Hospital Outpatient Department Setting Most third-party payers, including Medicare, state Medicaid plans, managed care organizations, indemnity plans and others, provide coverage for TREANDA. Claims Submission Hospital Outpatient Department (HOPD) facilities submit a CMS-1450 (also known as Universal Billing form or UB-04) claim form or its electronic equivalent for TREANDA to the appropriate Medicare Administrative Contractor (MAC), Fiscal Intermediary (FI) or non-Medicare payer. HOPD providers report various codes on the claim form to indicate the medical necessity for TREANDA and its administration in order to receive proper payment from payers. Bill Type Hospitals report the type of care provided and the sequence of the claim in a particular episode of care (also referred to as a “frequency” code) with four-digit Type of Bill codes. The first digit is always a leading “zero.” The second digit identifies the type of facility, e.g. Hospital 1. The third digit identifies the bill classification, e.g., Outpatient 3. The fourth digit identifies the frequency code. This code is reported in Field 4 TYPE of BILL on the CMS-1450 claim form. Bill Type CMS-1450 Location 013X Hospital Outpatient Field 4   Diagnosis Code(s) All payers recognize International Classification of Drugs, 9th Revision, Clinical Modification (ICD-9-CM) diagnosis codes to indicate the medical necessity for TREANDA. Payers may delay processing, deny or reject claims without valid diagnoses, requiring the HOPD to complete and resubmit a corrected claim. The HOPD must list an appropriate diagnosis code for TREANDA in Field 66-67 DX (Diagnosis) of the CMS-1450 claim form. Codes are selected based on the diagnosis documented in the patient's medical record. TREANDA for Injection is indicated for the treatment of patients with: Chronic lymphocytic leukemia (CLL). Efficacy relative to first line therapies other than chlorambucil has not been established. Indolent B-cell non-Hodgkin's lymphoma (NHL) that has progressed during or within six months of treatment with rituximab or a rituximab-containing regimen. The following serious adverse reactions have been associated with TREANDA in clinical trials: myelosuppression, infections, infusion reactions and anaphylaxis, tumor lysis syndrome, skin reactions, and other malignancies. ICD-9-CM Code (Non-Hodgkin's Lymphoma) CMS-1450 Location 200.10-200.18 Lymphosarcoma Field 66-67 200.30-200.38 Marginal Zone lymphoma 202.00-202.08 Nodular lymphoma ICD-9-CM Code (Chronic Lymphocytic Leukemia) CMS-1450 Location 204.10 Lymphoid leukemia, chronic, without mention of remission Field 66-67 204.11 Lymphoid leukemia, chronic, in remission 204.12 Lymphoid leukemia, chronic, in relapse (effective 10/1/08) ICD-9-CM Code (Encounter for Chemotherapy) CMS-1450 Location V58.11 Encounter for chemotherapy Field 66-67 The fifth digit identifies further specificity regarding location: 0 = unspecified site, extranodal and solid organ sites, 1 = lymph nodes of head, face, and neck, 2 = intrathoracic lymph nodes, 3 = intra-abdominal lymph nodes, 4 = lymph nodes of axilla and upper limb, 5 = lymph nodes of inguinal region and lower limb, 6 = intrapelvic lymph nodes, 7 = spleen, 8 = lymph nodes of multiple sites   The primary diagnosis for CLL is reported with an ICD-9-CM code in the 204.10 – 204.12 range. For NHL, an ICD-9-CM code in the 200 or 202 series is listed as the primary diagnosis. Depending on your MAC, Fiscal Intermediary or other payer, ICD-9-CM code V58.11 may be required as a secondary diagnosis code when TREANDA is administered at the encounter for chemotherapy. TREANDA Drug Code Healthcare Common Procedure Coding System (HCPCS) Level 2 codes are used to report drugs. TREANDA is reported with specific HCPCS J code, J9033, in Field 44 HCPCS/RATE/HIPPS Code of the CMS 1450 claim form. HCPCS CMS-1450 Location J9033 Bendamustine HCl, 1mg Field 44   HCPCS J9033 has a specific value of 1mg that represents a part of a TREANDA vial. Providers must report multiple units on the claim form to report an entire vial of TREANDA. For example, usage of a 100mg Single Use Vial (SUV) of Treanda is reported with 100 units in Field 46 SERV.UNITS. It is important to report on the CMS-1450 all of the drug that was used including the total amount of TREANDA administered and discarded since most payers will reimburse for the amount of drug administered and wasted. The medical record documentation should include: Number of single use vials of TREANDA purchased Amount of drug administered Amount of drug discarded Reason why it was discarded, e.g., partial drug from an SUV was required TREANDA Administration Code Healthcare Common Procedure Coding System (HCPCS) Level 1 codes, more commonly known as Current Procedural Terminology (CPT) codes are used to report the administration of TREANDA. Based on the FDA approved method of administration for TREANDA, the HOPD must list an appropriate CPT code for the Intravenous (IV) infusion in Field 44 PROCEDURE or SERVICE of the CMS-1450 claim form. CPT Administration Codes CMS-1450 Location 96413 Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug Field 44 96415 Chemotherapy administration, intravenous infusion technique; each additional hour 96417 Each additional sequential infusion (different substance/drug), up to 1 hour (list separately in addition to code for primary procedure)   Per prescribing information, TREANDA is administered via a 30 or 60-minute IV infusion depending on the indication. Per CPT code guidelines, an IV infusion lasting greater than 15 minutes and up to 90 minutes is reported with one unit (Field 46) of CPT code 96413 (Field 44). Medical justification for IV infusion times for TREANDA should be clearly documented in the medical record with start and stop times. Although typically reserved for inpatient hospital services, some payers require the administration of TREANDA be reported with an ICD-9-CM Procedure code in addition to a CPT code. An ICD-9-CM Procedure code is reported in Field 74 PRINCIPAL PROCEDURE or 74a – 74e OTHER PROCEDURE of the CMS-1450 claim form. ICD-9-CM CMS-1450 Location 99.25 Injection or infusion of cancer chemotherapeutic substance Field 74, 74a-74e   Revenue Codes The HOPD is required to indicate a Revenue Code in Field 42 REV. CD. and Revenue Code description in Field 43 DESCRIPTION. Revenue codes identify a specific accommodation (where a service was performed) and/or ancillary charge (the actual service performed).   CPT CMS-1450 Location J9033 | Rev Code: 0636 Bendamustine HCl, 1mg Field 42,43 96413 | Rev Code: 0335 Chemotherapy Infusion 96415 | Rev Code: 0335 Chemotherapy Infusion   This guide is provided for informational purposes only and is not intended to be an all inclusive list. You are responsible for the accuracy of any claims, invoices, and related documentation submitted to payers. Please contact the payer and consult source documents to verify codes and billing requirements. Cephalon Oncology does not guarantee success in obtaining insurance payments.   Revision Date: 9/22/2009   CORE HOME | TERMS OF USE | CONTACT US | PRIVACY | SITE MAP | HIPAA PRESCRIBING INFORMATION IMPORTANT SAFETY INFORMATION BOXED WARNING PRESCRIBING INFORMATION   United States Residents: Disclaimer: These sections are intended to provide information for residents of the U.S. only.