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) |
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HCPCS indicates Healthcare Common Procedure Coding System. |