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

Kristin A. Esposito, CPhT

May 2017, Vol 7, No 5 - Cancer Drug Coding


This detailed article of codes related to brain 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 brain cancer.

The following sections include:

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

C71 Malignant neoplasm of Brain
  C71.0 Malignant neoplasm of cerebrum, except lobes and ventricles
  C71.1 Malignant neoplasm of frontal lobe
  C71.2 Malignant neoplasm of temporal lobe
  C71.3 Malignant neoplasm of parietal lobe
  C71.4 Malignant neoplasm of occipital lobe
  C71.5 Malignant neoplasm of cerebral ventricle
  C71.6 Malignant neoplasm of cerebellum
  C71.7 Malignant neoplasm of brain stem
  C71.8 Malignant neoplasm of overlapping sites of brain
  C71.9 Malignant neoplasm of brain, unspecified
Generic (brand) name HCPCS code—code description FDA approved for brain cancer Compendia off-label uses for brain cancer Possible CPT® administration codes
aldesleukin (Proleukin) J9015 – Injection, aldesleukin, per
single-use vial
  96409
betamethasone acetate and betamethasone sodium phosphate (Celestone Soluspan) J0702 – Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg   11900, 11901, 20600, 20605, 20610, 96372
bevacizumab (Avastin) J9035 – Injection, bevacizumab, 10 mg   96413, 96415
bleomycin (Blenoxane) J9040 – Injection, bleomycin sulfate, 15 units   96401, 96409
carboplatin (Paraplatin) J9045 – Injection, carboplatin, 50 mg   96409, 96413, 96415
carmustine (BiCNU) J9050 – Injection, carmustine, 100 mg   96413, 96415
cisplatin (Platinol-AQ) J9060 – Injection, cisplatin, powder or solution, per 10 mg   96409, 96413, 96415
cyclophosphamide (Cytoxan) J8530 – Cyclophosphamide, oral, 25 mg   N/A
cyclophosphamide (Cytoxan) J9070 – Cyclophosphamide, 100 mg   96409, 96413, 96415
dexamethasone (Decadron) J8540 – Dexamethasone, oral, 0.25 mg   N/A
dexamethasone sodium phosphate (Decadron) J1100 – Injection, dexamethasone sodium phosphate, 1 mg   11900, 11901, 20600, 20605, 20610, 96372, 96374
etoposide (Vepesid) J8560 – Etoposide, oral, 50 mg   N/A
etoposide (Etopophos, Toposar) J9181 – Injection, etoposide, 10 mg   96413, 96415
everolimus (Afinitor ONLY) C9399* – Unclassified drugs or biologicals (Hospital outpatient use only)   N/A
everolimus (Afinitor ONLY) J8999* – Prescription drug, oral, chemotherapeutic, not otherwise specified   N/A
fluorouracil (Adrucil) J9190 – Injection, fluorouracil, 500 mg   96409
hydrocortisone sodium succinate (Solu-Cortef) J1720 – Injection, hydrocortisone sodium succinate, up to 100 mg   96365, 96366, 96372, 96374
hydroxyurea (Hydrea) S0176 – Hydroxyurea, oral, 500 mg   N/A
hydroxyurea (Hydrea) J8999* – Prescription drug, oral, chemotherapeutic, not otherwise specified   N/A
ifosfamide (Ifex) J9208 – Injection, ifosfamide, 1 g   96413, 96415
irinotecan (Camptosar) J9206 – Injection, irinotecan, 20 mg   96413, 96415
lomustine (eg, CeeNU, Gleostine) S0178 – Lomustine, oral, 10 mg   N/A
lomustine (eg, CeeNU, Gleostine) J8999* – Prescription drug, oral, chemotherapeutic, not otherwise specified   N/A
methylprednisolone (Depo-Medrol) J1020 – Injection, methylprednisolone acetate, 20 mg   11900, 11901, 20600, 20605, 20610, 96372, 96374
methylprednisolone (Depo-Medrol) J1030 – Injection, methylprednisolone acetate, 40 mg   11900, 11901, 20600, 20605, 20610, 96372
methylprednisolone (Depo-Medrol) J1040 – Injection, methylprednisolone acetate, 80 mg   11900, 11901, 20600, 20605, 20610, 96372
methylprednisolone (Medrol) J7509 – Methylprednisolone, oral,
per 4 mg
  N/A
methylprednisolone (Solu-Medrol) J2920 – Injection, methylprednisolone sodium succinate, up to 40 mg   96365, 96366, 96372, 96374
methylprednisolone (Solu-Medrol) J2930 – Injection, methylprednisolone sodium succinate, up to 125 mg   96365, 96366, 96372, 96374
paclitaxel (Taxol) J9265 – Injection, paclitaxel, 30 mg   96413, 96415
prednisolone (eg, Millipred, Prelone) J7510 – Prednisolone, oral, per 5 mg   N/A
prednisone (eg, Deltasone, Orasone) J7512 – Prednisone, immediate release
or delayed release, oral, 1 mg
  N/A
procarbazine (Matulane) S0182 – Procarbazine hydrochloride,
oral, 50 mg
  N/A
procarbazine (Matulane) J8999* – Prescription drug, oral, chemotherapeutic, not otherwise specified   N/A
tamoxifen (Nolvadex) S0187 – Tamoxifen citrate, oral, 10 mg   N/A
tamoxifen (Nolvadex) J8999* – Prescription drug, oral, chemotherapeutic, not otherwise specified   N/A
temozolomide (Temodar) J8700 – Temozolomide, oral, 5 mg   N/A
temozolomide (Temodar) J9328 – Injection, temozolomide, 1 mg   96413, 96415
teniposide (Vumon) Q2017 – Injection, teniposide, 50 mg   96413, 96415
thiotepa (Thiotepa) J9340 – Injection, thiotepa, 15 mg   51720, 96409
topotecan (Hycamtin) J9351 – Injection, topotecan, 0.1 mg   96413
vinBLAStine (Velban) J9360 – Injection, vinblastine sulfate, 1 mg   96409
vinCRIStine (Vincasar PFS) J9370 – Vincristine sulfate, 1 mg   96409
*When billing a nonclassified medication using a CMS 1500 claim form you must include both the HCPCS code (eg, J8999 Hydrea) 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 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)
HCPCS indicates Healthcare Common Procedure Coding System.
RJ Health Systems