This detailed article of codes related to colorectal 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 colorectal cancer.
The following sections include:- Associated ICD-10-CM codes used for the classification of colorectal cancer
- Drugs that have been approved by the FDA for the treatment of colorectal cancer
- Drugs that are Compendia-listed for off-label use for colorectal 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
C18 | Malignant neoplasm of colon | ||
C18.0 | Cecum | ||
C18.1 | Appendix | ||
C18.2 | Ascending colon | ||
C18.3 | Hepatic flexure | ||
C18.4 | Transverse colon | ||
C18.5 | Splenic flexure | ||
C18.6 | Descending colon | ||
C18.7 | Sigmoid colon | ||
C18.8 | Overlapping sites of colon | ||
C18.9 | Colon, unspecified | ||
C19 | Malignant neoplasm of rectosigmoid junction | ||
C20 | Malignant neoplasm of rectum |
Generic (brand) name | HCPCS code—code description | FDA approved for colorectal cancer | Compendia off-label uses for colorectal cancer | Possible CPT® administration codes |
Bacillus Calmette-Guérin (BCG Vaccine) | 90585 - Bacillus Calmette-Guérin vaccine (BCG) for tuberculosis, live, for percutaneous use | ✔ | 90471, 90472 | |
Bacillus Calmette-Guérin (TheraCys, Tice BCG) | 90586 - Bacillus Calmette-Guérin vaccine (BCG) for bladder cancer, live, for intravesical use | ✔ | 51720 | |
Bacillus Calmette-Guérin (TheraCys, Tice BCG) | J9031 - bCG (intravesical), per installation | ✔ | 51720 | |
bevacizumab (Avastin) | J9035 - Injection, bevacizumab, 10 mg | ✔ | 96413, 96415 | |
capecitabine (Xeloda) | J8520 - Capecitabine, oral, 150 mg | ✔ | N/A | |
capecitabine (Xeloda) | J8521 - Capecitabine, oral, 500 mg | ✔ | N/A | |
carmustine (BiCNU) | J9050 - Injection, carmustine, 100 mg | ✔ | 96413, 96415 | |
cetuximab (Erbitux) | J9055 - Injection, cetuximab, 10 mg | ✔ | 96413, 96415 | |
cisplatin (Platinol AQ) | J9060 - Injection cisplatin, powder or solution, per 10 mg | ✔ | 96409, 96413, 96415 | |
floxuridine (FUDR) | J9200 - Injection, floxuridine, 500 mg | ✔ | 96422, 96423, 96425 | |
fluorouracil (Adrucil) | J9190 - Injection, fluorouracil, 500 mg | ✔ | 96409 | |
hydroxyurea (Hydrea) | J8999* - Prescription drug, oral, chemotherapeutic, not otherwise specified | ✔ | N/A | |
hydroxyurea (Hydrea) | S0176 - Hydroxyurea, oral, 500 mg | ✔ | N/A | |
irinotecan (Camptosar) | J9206 - Injection, irinotecan, 20 mg | ✔ | 96413, 96415 | |
leucovorin calcium (Wellcovorin) | J0640 - Injection, leucovorin calcium, per 50 mg | ✔ | 96372, 96374, 96409 | |
levoleucovorin calcium (Fusilev) | J0641 - Injection, levoleucovorin calcium, 0.5 mg | ✔ | 96365, 96366 | |
lomustine (CeeNu) | J8999* - Prescription drug, oral, chemotherapeutic, not otherwise specified | ✔ | N/A | |
lomustine (CeeNu) | S0178 - Lomustine, oral, 10 mg | ✔ | N/A | |
mitomycin (Mutamycin) | J9280 - Mitomycin, 5 mg | ✔ | 96409 | |
octreotide (Sandostatin LAR) | J2353 - Injection, octreotide, depot form for intramuscular injection, 1 mg | ✔ | 96372 | |
octreotide (Sandostatin) | J2354 - Injection, octreotide, non-depot form for subcutaneous or intravenous injection, 25 mcg | ✔ | 96365, 96372, 96374 | |
oxaliplatin (Eloxatin) | J9263 - Injection, oxaliplatin, 0.5 mg | ✔ | 96413, 96415 | |
panitumumab (Vectibix) | J9303 - Injection, panitumumab, 10 mg | ✔ | 96413, 96415 | |
pemetrexed (Alimta) | J9305 - Injection, pemetrexed, 10 mg | ✔ | 96409 | |
ramucirumab (Cyramza) | J9308 - Injection, ramucirumab, 5 mg | ✔ | 96413, 96415 | |
regorafenib (Stivarga) | C9399* - Unclassified drugs or biologicals (Hospital outpatient use only) | ✔ | N/A | |
regorafenib (Stivarga) | J8999* - Prescription drug, oral, chemotherapeutic, not otherwise specified | ✔ | N/A | |
topotecan (Hycamtin) | J8705 - Topotecan, oral, 0.25 mg | ✔ | N/A | |
topotecan (Hycamtin) | J9351 - Injection, topotecan, 0.1 mg | ✔ | 96413 | |
trifluridine and tipiracil (Lonsurf) | C9399* - Unclassified drugs or biologicals (Hospital outpatient use only) | ✔ | N/A | |
trifluridine and tipiracil (Lonsurf) | J8999* - Prescription drug, oral, chemotherapeutic, not otherwise specified | ✔ | N/A | |
vincristine (Vincasar PFS) | J9370 - Vincristine sulfate, 1 mg | ✔ | 96409 | |
ziv-aflibercept (Zaltrap) | J9400 - Injection, ziv-aflibercept, 1 mg | ✔ | 96413 | |
*When billing a nonclassified medication using a CMS 1500 claim form you must include both the HCPCS code (eg, J8999 Stivarga) 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 your payer regarding the correct placement of medication information. | ||||
References • HCPCS Level II Expert 2017 • Current Procedural Terminology (CPT®) 2017 • CPT Copyright © 2017 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association • ICD-10-CM for Professionals Volumes 1 & 2 2017 • 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, Healthcare Common Procedure Coding System. |