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) |
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HCPCS indicates Healthcare Common Procedure Coding System. |