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

Kristin A. Esposito, CPhT

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

Cancer Drug Coding, ICD Codes, Reimbursement

Clinical Services Manager, RJ Health Systems

This detailed article of codes related to lung 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 lung cancer.

The following sections include:

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

C34	Malignant neoplasm of bronchus and lung
	C34.0	Malignant neoplasm of main bronchus
	C34.00	Malignant neoplasm of unspecified main bronchus
		C34.01	Malignant neoplasm of right main bronchus
		C34.02	Malignant neoplasm of left main bronchus
	C34.1	Malignant neoplasm of upper lobe, bronchus or lung
	C34.10	Malignant neoplasm of upper lobe, unspecified bronchus or lung
		C34.11	Malignant neoplasm of upper lobe, right bronchus or lung
		C34.12	Malignant neoplasm of upper lobe, left bronchus or lung
	C34.2	Malignant neoplasm of middle lobe, bronchus or lung
	C34.3	Malignant neoplasm of lower lobe, bronchus or lung
	C34.30	Malignant neoplasm of lobe, unspecified bronchus or lung
		C34.31	Malignant neoplasm of lower lobe, right bronchus or lung
		C34.32	Malignant neoplasm of lower lobe, left bronchus or lung
	C34.8	Malignant neoplasm of overlapping sites of bronchus and lung
	C34.80	Malignant neoplasm of overlapping sites of unspecified bronchus and lung
		C34.81	Malignant neoplasm of overlapping sites of right bronchus and lung
		C34.82	Malignant neoplasm of overlapping sites of left bronchus and lung
	C34.9	Malignant neoplasm of unspecified part of bronchus or lung
	C34.90	Malignant neoplasm of unspecified part of unspecified bronchus or lung
		C34.91	Malignant neoplasm of unspecified part of right bronchus or lung
		C34.92	Malignant neoplasm of unspecified part of left bronchus or lung

Generic (brand) name

HCPCS code—code description

FDA approved for lung cancer

Compendia off-label uses for lung cancer

Possible CPT^® administration codes

afatinib (Gilotrif)	C9399* - Unclassified drugs or biological (Hospital outpatient use only)	✔		N/A
afatinib (Gilotrif)	J8999* - Prescription drug, oral, chemotherapeutic, not otherwise specified	✔		N/A
alectinib (Alecensa)	C9399* - Unclassified drugs or biological (Hospital outpatient use only)	✔		N/A
alectinib (Alecensa)	J8999* - Prescription drug, oral, chemotherapeutic, not otherwise specified	✔		N/A
amifostine (Ethyol)	J0207 - Injection, amifostine, 500 mg		✔	96374
Bacillus Calmette-Guerin (BCG Vaccine)	90585 - Bacillus Calmette-Guerin vaccine (BCG) for tuberculosis, live, for percutaneous use		✔	90471, 90472
Bacillus Calmette-Guerin (Theracys, Tice BCG)	90586 - Bacillus Calmette-Guerin vaccine (BCG) for bladder cancer, live, for intravesical use		✔	51720
Bacillus Calmette-Guerin (Theracys, Tice BCG)	J9031 - BCG (intravesical), per installation		✔	51720
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
ceritinib (Zykadia)	C9399* - Unclassified drugs or biological (Hospital outpatient use only)	✔		N/A
ceritinib (Zykadia)	J8999* - Prescription drug, oral, chemotherapeutic, not otherwise specified	✔		N/A
cetuximab (Erbitux)	J9055 - Injection, cetuximab, 10 mg		✔	96413, 96415
cisplatin (Platinol AQ)	J9060 - Injection, cisplatin, powder or solution, per 10 mg		✔	96409, 96413, 96415
crizotinib (Xalkori)	C9399* - Unclassified drugs or biological (Hospital outpatient use only)	✔		N/A
crizotinib (Xalkori)	J8999* - Prescription drug, oral, chemotherapeutic, not otherwise specified	✔		N/A
cyclophosphamide (Cytoxan)	J8530 - Cyclophosphamide, oral, 25 mg		✔	N/A
cyclophosphamide (Cytoxan)	J9070 - Cyclophosphamide, 100 mg		✔	96409, 96413, 96415
docetaxel (Taxotere)	J9171 - Injection, docetaxel, 1 mg	✔		96413
doxorubicin HCl (Adriamycin)	J9000 - Injection, doxorubicin hydrochloride, 10 mg	✔		96409
doxorubicin (Doxil)	Q2050 - Injection, doxorubicin hydrochloride, liposomal, 10 mg, not otherwise specified		✔	96413
epirubicin (Ellence)	J9178 - Injection, epirubicin HCl, 2 mg		✔	96409, 96413
erlotinib (Tarceva)	C9399* - Unclassified drugs or biological (Hospital outpatient use only)	✔		N/A
erlotinib (Tarceva)	J8999* - Prescription drug, oral, chemotherapeutic, not otherwise specified	✔		N/A
etoposide (Vepesid)	J8560 - Etoposide, oral, 50 mg	✔		N/A
etoposide (Etopophos, Toposar)	J9181 - Injection, etoposide, 10 mg	✔		96413, 96415
fluorouracil (Adrucil)	J9190 - Injection, fluorouracil, 500 mg		✔	96409
gefitinib (Iressa)	J8565 - Gefitinib, oral, 250 mg	✔		N/A
gemcitabine (Gemzar)	J9201 - Injection, gemcitabine hydrochloride, 200 mg	✔		96413
ifosfamide (Ifex)	J9208 - Injection, ifosfamide, 1 gram		✔	96413, 96415
irinotecan (Camptosar)	J9206 - Injection, irinotecan, 20 mg		✔	96413, 96415
lomustine (CeeNU)	J8999* - Prescription drug, oral, chemotherapeutic, not otherwise specified		✔	N/A
lomustine (CeeNU)	S0178 - Lomustine, oral, 10 mg		✔	N/A
mechlorethamine HCl (Mustargen)	J9230 - Injection, mechlorethamine hydrochloride (nitrogen mustard), 10 mg	✔		96409
methotrexate (Trexall)	J8610 - Methotrexate, oral, 2.5 mg	✔		N/A
methotrexate	J9250 - Methotrexate sodium, 5 mg	✔		96372, 96374, 96401, 96409, 96450
methotrexate	J9260 - Methotrexate sodium, 50 mg	✔		96372, 96374, 96401, 96409, 96450
metoclopramide (Reglan IV only)	J2765 - Injection, metoclopramide HCl, up to 10 mg		✔	96372, 96374
mitomycin (Mutamycin)	J9280 - Injection, mitomycin, 5 mg		✔	96409
necitumumab (Portrazza)	C9475 - Injection, necitumumab, 1 mg	✔		96413
necitumumab (Portrazza)	J9999 - Not otherwise classified, antineoplastic drugs	✔		96413
nivolumab (Opdivo)	J9299 - Injection, nivolumab, 1 mg	✔		96413, 96415
oxaliplatin (Eloxatin)	J9263 - Injection, oxaliplatin, 0.5 mg		✔	96413, 96415
paclitaxel protein-bound particles (Abraxane)	J9264 - Injection, paclitaxel protein-bound particles, 1 mg	✔		96413
paclitaxel (Taxol)	J9265 - Injection, paclitaxel, 30 mg	✔		96413, 96415
panitumumab (Vectibix)	J9303 - Injection, panitumumab, 10 mg		✔	96413, 96415
pembrolizumab (Keytruda)	J9271 - Injection, pembrolizumab, 1 mg	✔		96413
pemetrexed (Alimta)	J9305 - Injection, pemetrexed, 10 mg	✔		96409
porfimer sodium (Photofrin)	J9600 - Injection, porfimer sodium, 75 mg	✔		96409
ramucirumab (Cyramza)	J9308 - Injection, ramucirumab, 5 mg	✔		96413, 96415
tamoxifen (Nolvadex)	J8999* - Prescription drug, oral, chemotherapeutic, not otherwise specified		✔	N/A
tamoxifen (Nolvadex)	S0187 - Tamoxifen citrate, oral, 10 mg		✔	N/A
temozolomide (Temodar)	J8700 - Temozolomide, oral, 5 mg		✔	N/A
teniposide (Vumon)	Q2017 - Injection, teniposide, 50 mg		✔	96413, 96415
topotecan (Hycamtin)	J8705 - Topotecan, oral, 0.25 mg	✔		N/A
topotecan (Hycamtin)	J9351 - Injection, topotecan, 0.1 mg	✔		96413
trastuzumab (Herceptin)	J9355 - Injection, trastuzumab, 10 mg		✔	96413, 96415
vinBLAStine (Velban)	J9360 - Injection, vinblastine sulfate, 1 mg		✔	96409
vinCRIStine (Vincasar PFS)	J9370 - Vincristine sulfate, 1 mg		✔	96409
vinorelbine (Navelbine)	J9390 - Injection, vinorelbine tartrate,per 10 mg	✔		96409
When billing a nonclassified medication using a CMS 1500 claim form you must include both the HCPCS code (ie, J8999 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.

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

Associated ICD-10-CM Codes

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Associated ICD-10-CM Codes

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