Reporting Trastuzumab? Here Are All the Codes You Need to Know

trastuzumab HCPCS updates practices need to know

Trastuzumab HCPCS codes have been multiplying lately. The July 2019 HCPCS updates brought five changes. And there are two more planned for Oct. 1, 2019, implementation. Make sure your coding for this monoclonal antibody is up to date with these tips.

Know the Trastuzumab Codes You Have Right Now

Oncology coders need to know about trastuzumab because doctors use it to treat breast cancer and, in some cases, gastric cancer. The current HCPCS code set, effective July 1, 2019, made one revision to an existing code, added three temporary Q codes, and added a J code, too, all related to trastuzumab.

First, the descriptor for J9355 changed to add the phrase “excludes biosimilar”:

  • Before July 1: J9355 (Injection, trastuzumab, 10 mg)
  • July 1 and later: J9355 (Injection, trastuzumab, excludes biosimilar, 10 mg).

This two-word change was part of the larger overhaul of trastuzumab coding that added three new codes for biosimilars. Note that each descriptor specifies the brand name the code applies to:

  • Q5112 (Injection, trastuzumab-dttb, biosimilar, (Ontruzant), 10 mg)
  • Q5113 (Injection, trastuzumab-pkrb, biosimilar, (Herzuma), 10 mg)
  • Q5114 (Injection, Trastuzumab-dkst, biosimilar, (Ogivri), 10 mg).

The above codes are Q codes, marking them as temporary codes. July also brought a new permanent J code, J9356 (Injection, trastuzumab, 10 mg and Hyaluronidase-oysk), which allows you to use a specific code to report Herceptin Hylecta.

Tip: For a clearer picture of how some of these biosimilars vary, look at the May 14, 2019, CMS HCPCS Public Meeting Agenda.

Watch for These 2 Trastuzumab Codes in October

CMS recently posted a list of HCPCS codes that will be implemented Oct. 1, 2019 (as well as some  appropriate use criteria [AUC] modifiers planned for Jan. 1, 2020). Among the new codes are two for trastuzumab biosimilars:

  • Q5116 (Injection, trastuzumab-qyyp, biosimilar, (Trazimera), 10 mg)
  • Q5117 (Injection, trastuzumab-anns, biosimilar, (Kanjinti), 10 mg).

Again these are Q codes, which means the codes for the specific brand names listed may have code changes in the future, likely to J codes. Keep an eye out for even more trastuzumab-related code updates in the future.

Helpful: Reporting units accurately is one of the trickier parts of HCPCS coding because you must take into account the amount listed in the code descriptor. All of the codes in this post reference 10 mg in their descriptors. That means you’ll report 1 billing unit of the code for every 10 mg.

What About You?

If you use a hard-copy HCPCS manual, how do you make sure you have the quarterly updates for HCPCS codes available to check and use? Do you like having codes that specify brand names?

About 

Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

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