Ace the ABCs of ABVD With These HCPCS and CPT Essentials

Make this J9040 mistake and you'll end up reporting 15 times more units than you should.

The ABVD regimen for the treatment of Hodgkin's disease may have been around since the 1970s, however the way you report the service to insurance companies has definitely seen some changes over the years. Get the proper CPT and HCPCS coding choices down pat with the help of tips and tactics below.

Capture Drug Dollars With These HCPCS Codes

"ABVD" refers to the first letters of the drugs which are used in the regimen, which consist of Adriamycin, bleomycin, vinblastine, and dacarbazine.

Adriamycin: Coded using HCPCS code J9000 (Injection, doxorubicin hydrochloride, 10 mg), Adriamycin is a brand name for generic chemotherapy drug doxorubicin whose specialties consist of hematology and oncology. You also may find doxorubicin sold under the brand name Rubex.

Bleomycin: One more chemotherapy drug, bleomycin is marketed under the brand name Blenoxane and is coded using J9040 (Injection, bleomycin sulfate, 15 units).

Vinblastine: Sold under names like Velban and Alkaban-AQ, vinblastine is also a chemotherapy drug. Report it using code J9360 (Injection, vinblastine sulfate, 1 mg).

Dacarbazine: You may see this chemotherapy drug sold under the name DTIC-Dome. Your code selection will depend on the amount of drug used: HCPCS code J9130 (Dacarbazine, 100 mg) or J9140 (Dacarbazine, 200 mg).

Make Things Easier by Following an ABVD Example

For ABVD, the patient usually gets pushes of bleomycin, doxorubicin, and vinblastine. The patient also gets an intravenous infusion of dacarbazine. The oncologist will order the dosage based on the patient's body mass.

Example: A nurse administers the following to a patient who is suffering from Hodgkin's disease (201.x, Hodgkin's disease):

18.9 units bleomycin, IV push, 9 minutes

47.25 mg doxorubicin, IV push, 5 minutes

11.34 mg vinblastine, IV push, 2 minutes

708.75 mg dacarbazine, IV infusion, 1 hour.

CPT solution: Supposing the one-hour dacarbazine infusion is your initial service, you must assign initial infusion code 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug) for that particular service.

For each of the three chemotherapy IV pushes in the above example, you must report +96411 (Chemotherapy administration; intravenous, push technique, each additional substance/drug [List separately in addition tocode for primary procedure]). For maximum payers, you must report +96411 with a quantity of 3, however verify the accurate medical coding and billing reporting structure for your local commercial payers.

Watch for: The nurse also may administer an antiemetic with this regimen, so you must be wary of further reportable drugs and administration services.