Medications Used for the Treatment of Colorectal Cancer and Associated ICD-10 Codes

Kristin A. Esposito, CPhT

April 2017, Vol 7, No 4 - Cancer Drug Coding


This detailed article of codes related to colorectal cancer is intended to assist practice managers and other healthcare providers and payers to ensure the proper use of coding and billing information associated with the treatment of patients with colorectal cancer.

The following sections include:
  • Associated ICD-10-CM codes used for the classification of colorectal cancer
  • Drugs that have been approved by the FDA for the treatment of colorectal cancer
  • Drugs that are Compendia-listed for off-label use for colorectal cancer based on clinical studies that suggest beneficial use in some cases. Please note: If a check mark appears in the FDA column, it will NOT appear in the Compendia off-label use column
  • Corresponding HCPCS/CPT® codes and code descriptions
  • Possible CPT® administration codes for the drugs

Associated ICD-10-CM Codes:

C18 Malignant neoplasm of colon
  C18.0 Cecum
  C18.1 Appendix
  C18.2 Ascending colon
  C18.3 Hepatic flexure
  C18.4 Transverse colon
  C18.5 Splenic flexure
  C18.6 Descending colon
  C18.7 Sigmoid colon
  C18.8 Overlapping sites of colon
  C18.9 Colon, unspecified
C19 Malignant neoplasm of rectosigmoid junction
C20 Malignant neoplasm of rectum
Generic (brand) name HCPCS code—code description FDA approved for colorectal cancer Compendia off-label uses for colorectal cancer Possible CPT® administration codes
Bacillus Calmette-Guérin (BCG Vaccine) 90585 – Bacillus Calmette-Guérin vaccine (BCG) for tuberculosis, live, for percutaneous use   90471, 90472
Bacillus Calmette-Guérin (TheraCys, Tice BCG) 90586 – Bacillus Calmette-Guérin vaccine (BCG) for bladder cancer, live, for intravesical use   51720
Bacillus Calmette-Guérin (TheraCys, Tice BCG) J9031 – bCG (intravesical), per installation   51720
bevacizumab (Avastin) J9035 – Injection, bevacizumab, 10 mg   96413, 96415
capecitabine (Xeloda) J8520 – Capecitabine, oral, 150 mg   N/A
capecitabine (Xeloda) J8521 – Capecitabine, oral, 500 mg   N/A
carmustine (BiCNU) J9050 – Injection, carmustine, 100 mg   96413, 96415
cetuximab (Erbitux) J9055 – Injection, cetuximab, 10 mg   96413, 96415
cisplatin (Platinol AQ) J9060 – Injection cisplatin, powder or solution, per 10 mg   96409, 96413, 96415
floxuridine (FUDR) J9200 – Injection, floxuridine, 500 mg   96422, 96423, 96425
fluorouracil (Adrucil) J9190 – Injection, fluorouracil, 500 mg   96409
hydroxyurea (Hydrea) J8999* – Prescription drug, oral, chemotherapeutic, not otherwise specified   N/A
hydroxyurea (Hydrea) S0176 – Hydroxyurea, oral, 500 mg   N/A
irinotecan (Camptosar) J9206 – Injection, irinotecan, 20 mg   96413, 96415
leucovorin calcium (Wellcovorin) J0640 – Injection, leucovorin calcium, per 50 mg   96372, 96374, 96409
levoleucovorin calcium (Fusilev) J0641 – Injection, levoleucovorin calcium, 0.5 mg   96365, 96366
lomustine (CeeNu) J8999* – Prescription drug, oral, chemotherapeutic, not otherwise specified   N/A
lomustine (CeeNu) S0178 – Lomustine, oral, 10 mg   N/A
mitomycin (Mutamycin) J9280 – Mitomycin, 5 mg   96409
octreotide (Sandostatin LAR) J2353 – Injection, octreotide, depot form for intramuscular injection, 1 mg   96372
octreotide (Sandostatin) J2354 – Injection, octreotide, non-depot form for subcutaneous or intravenous injection, 25 mcg   96365, 96372, 96374
oxaliplatin (Eloxatin) J9263 – Injection, oxaliplatin, 0.5 mg   96413, 96415
panitumumab (Vectibix) J9303 – Injection, panitumumab, 10 mg   96413, 96415
pemetrexed (Alimta) J9305 – Injection, pemetrexed, 10 mg   96409
ramucirumab (Cyramza) J9308 – Injection, ramucirumab, 5 mg   96413, 96415
regorafenib (Stivarga) C9399* – Unclassified drugs or biologicals (Hospital outpatient use only)   N/A
regorafenib (Stivarga) J8999* – Prescription drug, oral, chemotherapeutic, not otherwise specified   N/A
topotecan (Hycamtin) J8705 – Topotecan, oral, 0.25 mg   N/A
topotecan (Hycamtin) J9351 – Injection, topotecan, 0.1 mg   96413
trifluridine and tipiracil (Lonsurf) C9399* – Unclassified drugs or biologicals (Hospital outpatient use only)   N/A
trifluridine and tipiracil (Lonsurf) J8999* – Prescription drug, oral, chemotherapeutic, not otherwise specified   N/A
vincristine (Vincasar PFS) J9370 – Vincristine sulfate, 1 mg   96409
ziv-aflibercept (Zaltrap) J9400 – Injection, ziv-aflibercept, 1 mg   96413
*When billing a nonclassified medication using a CMS 1500 claim form you must include both the HCPCS code (eg, J8999 Stivarga) in Item 24D and the drug name, strength, and NDC (National Drug Code) in Item 19 or 24A (shaded area) to ensure appropriate reimbursement. Please note: Check with your payer regarding the correct placement of medication information.
References
• HCPCS Level II Expert 2017
Current Procedural Terminology (CPT®) 2017
CPT Copyright © 2017 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association
ICD-10-CM for Professionals Volumes 1 & 2 2017
• FDA-approved indication (product Prescribing Information)
• Compendia references available upon request
• www.ReimbursementCodes.com powered by RJ Health Systems International, LLC, Rocky Hill, CT
• CMS (Centers for Medicare & Medicaid Services)
GM-CSF indicates granulocyte-macrophage colony-stimulating factor; HCPCS, Healthcare Common Procedure Coding System.
RJ Health Systems