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

Kristin A. Esposito, CPhT

January 2017, Vol 7, No 1 - ICD Codes


This detailed article of codes related to pancreatic 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 pancreatic cancer.

The following sections include:

  • Associated ICD-10-CM codes used for the classification of pancreatic cancer
  • Drugs that have been approved by the FDA for the treatment of pancreatic cancer
  • Drugs that are Compendia-listed for off-label use for pancreatic 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

C25 Malignant neoplasm of pancreas
  C25.0 Malignant neoplasm of head of pancreas
  C25.1 Malignant neoplasm of body of pancreas
  C25.2 Malignant neoplasm of tail of pancreas
  C25.3 Malignant neoplasm of pancreatic duct
  C25.4 Malignant neoplasm of endocrine pancreas
  C25.7 Malignant neoplasm of other parts of pancreas
  C25.8 Malignant neoplasm of overlapping sites of pancreas
  C25.9 Malignant neoplasm of pancreas, unspecified
Generic (brand) name HCPCS code—code description FDA approved for pancreatic cancers Compendia off-label uses for pancreatic cancers Possible CPT® administration codes
capecitabine (Xeloda) J8520 – Capecitabine, oral, 150 mg   N/A
capecitabine (Xeloda) J8521 – Capecitabine, oral, 500 mg   N/A
dacarbazine (DTIC-Dome) J9130 – Dacarbazine, 100 mg   96409, 96413
doxorubicin HCl (Adriamycin) J9000 – Injection, doxorubicin hydrochloride, 10 mg   96409
epirubicin (Ellence) J9178 – Injection, epirubicin HCl, 2 mg   96409, 96413
erlotinib (Tarceva) C9399* – Unclassified drugs or biologicals (Hospital outpatient use only)   N/A
erlotinib (Tarceva) J8999* – Prescription drug, oral, chemotherapeutic, not otherwise specified   N/A
fluorouracil (Adrucil) J9190 – Injection, fluorouracil, 500 mg   96409
flutamide (Eulexin) J8999* – Prescription drug, oral, chemotherapeutic, not otherwise specified   N/A
flutamide (Eulexin) S0175 – Flutamide, oral, 125 mg   N/A
gemcitabine (Gemzar) J9201 – Injection, gemcitabine hydrochloride, 200 mg   96413
irinotecan (Camptosar) J9206 – Injection, irinotecan, 20 mg   96413, 96415
irinotecan liposome (Onivyde) J9205 – Injection, irinotecan liposome, 1 mg (For billing prior to 1/1/17 use J9999 or C9474 for OPPS billing)   96413, 96415
leucovorin calcium (Wellcovorin) J0640 – Injection, leucovorin calcium, per 50 mg   96372, 96374, 96409
mitomycin (Mutamycin) J9280 – Injection, mitomycin, 5 mg   96409
octreotide (Sandostatin) J2354 – Injection, octreotide, nondepot form for subcutaneous or intravenous injection, 25 mcg   96365, 96372, 96374
octreotide (Sandostatin LAR) J2353 – Injection, octreotide, depot form for intramuscular injection, 1 mg   96372
oxaliplatin (Eloxatin) J9263 – Injection, oxaliplatin, 0.5 mg   96413, 96415
paclitaxel (Taxol) J9267- Injection, paclitaxel, 1 mg   96413, 96415
paclitaxel protein-bound particles (Abraxane) J9264 – Injection, paclitaxel protein-bound particles, 1 mg   96413
streptozocin (Zanosar) J9320 – Injection, streptozocin, 1 g   96409, 96413, 96415
tamoxifen (Nolvadex) J8999* – Prescription drug, oral, chemotherapeutic, not otherwise specified   N/A
tamoxifen (Nolvadex) S0187 – Tamoxifen citrate, oral, 10 mg   N/A
triptorelin (Trelstar) J3315 – Injection, triptorelin pamoate, 3.75 mg   96372, 96402
*When billing a nonclassified medication using a CMS 1500 claim form you must include both the HCPCS code (eg, J8999 for Tarceva) 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 payer regarding correct placement of medication information in Item 19 or 24A shaded area.
References
• HCPCS Level II Expert 2016
Current Procedural Terminology (CPT®) 2016
CPT Copyright © 2016 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association
ICD-10-CM for Professionals Volumes 1 & 2 2016
• 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)
HCPCS indicates Healthcare Common Procedure Coding System.