## **What is the HCPCS code J9173 for?**
The HCPCS code J9173's coding information is meant to denote the use of an injected medicine called durvalumab, specifically a dosage of 10 mg. This medicine is administered through an IV catheter and infusion pump.
The purpose of this medicine is to provide a boost to the body's immune system to help it destroy cancer cells, specifically non-small cell lung cancer (NSCLC), small cell lung cancer (SCLC), biliary tract cancer, unresectable hepatocellular carcinoma, bladder cancer, and endometrial cancer. It enhances anti‑tumor immunity by blocking PD‑L1/PD‑1 interaction.
The goal of the use of durvalumab is to boost the survival rate of patients by slowing the progression of their cancer and shrinking the tumors that have developed.
## **Documentation requirements for J9173**
This specific code, just like with other injected medications, requires proper documentation before being filed for billing and claims, especially if Medicare is the provider. Make sure to document the following:
- The full name of the personnel who administered the injection and their credentials
- The name and address of the facility where the injection was administered
- The full name of the patient
- The date and time of the drug administration by injection
- Patient records showing they have been diagnosed with any of the cancers mentioned above; indications listed may include locally advanced or metastatic NSCLC even after receiving chemotherapy, or even advanced urothelial carcinoma that was unaffected by platinum-based chemotherapy
- All test results that were conducted for the diagnosis (including the biopsies)
- A record of all adverse events, supportive care, and patient responses
- Blood tests (complete blood counts)
- Imaging test results showing the location and sizes of the malignant tumors
- Medical necessity for the use of the medicine
- Exact dosage of durvalumab
Please make sure the documentation is precise to avoid rejected reimbursements.
## **Billing requirements for J9173**
Other than the documentation requirements above, please note that you need to file this HCPCS code alongside the CPT code 96365 for intravenous infusion, for therapy, prophylaxis, or diagnosis.
You must also note the following:
- The documentation must reflect the dosage given throughout the treatment.
- Use either of the two modifiers: JW if there's unused medication in a vial (wastage), or JZ if there's no unused medication.
- This is part of the Centers for Medicare & Medicaid Services (CMS) mandates.
## **Other similar codes**
- J9318 - Injection, romidepsin, nonlyophilized, 0.1 mg
- J9307 - Injection, pralatrexate, 1 mg
- J9306 - Injection, pertuzumab, 1 mg
- J9320 - Injection, streptozocin, 1 g
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