The following sections will assist healthcare professionals and payers by providing appropriate coding and billing information associated with the treatment of pancreatic cancer. ICD-9 codes are no longer provided.
The following sections include:- Associated ICD-10-CM codes used for the classification of pancreatic cancer
- Drugs that have been FDA approved in 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
*When billing a nonclassified medication using a CMS 1500 claim form you must include both the HCPCS code (eg, J9999 Onivyde) in Item 24D and the drug name, strength, and NDC (National Drug Code) in Item 19 or 24A (shaded area) to ensure appropriate reimbursement. Note: Check with your payer regarding correct placement of medication information.
References:
- HCPCS Level II Expert 2016
- Current Procedural Terminology (CPT ®) 2016
- CPT Copyright © 2015 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)
