HCPCS Code Q5117: Injection, Trastuzumab-anns, Biosimilar, (Kanjinti), 10 mg

Learn about the HCPCS code Q5117 for "Injection, trastuzumab-anns, biosimilar, (kanjinti), 10 mg" through this guide.

## **What is the HCPCS code Q5117 for?** The HCPCS code Q5117 is meant to designate the provision of a transtuzumab-aans injection, specifically a 10 mg dosage of a biosimilar type of it (kanjinti). The purpose of this injection is to prevent the growth of cancer cells and help prevent tumors from growing and spreading. It can also reduce the size of tumors. Doing so will boost the life expectancy of patients with cancer. It is usually provided to an individual patient who did not respond well to prior therapy and other forms of treatment, and has any one of these types of cancers: - Breast cancer (e.g., HER2-positive metastatic breast cancer; HER2-positive early breast cancer) - Gastric cancer with HER2 overexpression (e.g., HER2-positive metastatic gastric or gastroesophageal junction adenocarcinoma) However, it is also used as first-line therapy (e.g., in combination with paclitaxel for metastatic breast cancer) and as adjuvant/neoadjuvant therapy (to prevent recurrence or reduce tumor size) where there has been no prior trastuzumab treatment.

## **Documentation requirements for Q5117** As with any HCPCS code, this one requires sufficient documentation. Please familiarize yourself with the coding guidelines and requirements set by your insurer, including related policy articles and local coverage determinations. For this specific code, here are examples of what you'll need: - The full name of the patient - The full names and credentials of the professionals handling the patient - The name and address of the facility where the injection was administered - The relevant information and indications, especially the diagnosis, of the patient's condition, to support medical necessity - Dosage and administration details (e.g., strength, route, and total mg given), vial usage, National Drug Code number, and drug manufacturer - Infusion notes, including start and stop times - Treatment plans, including the effective date of implementation - Documentation that the patient did not respond well to prior treatments - Blood test results - Imaging tests showing malignant neoplasm/tumor sizes and locations

## **Billing requirements for Q5117** Besides the documentation requirements above, please take note of or have the following: - Every 10 mg = 1 unit - Route of administration is IV infusion, so please use the appropriate primary procedure code CPT 96413, 96415, or 96417 - Use appropriate ICD codes based on the patient's cancer - Use either of two modifiers: JW if there's unused medication in a vial (wastage), or JZ if there's no unused medication.

## **Other similar codes** - **Q5116** - Injection, trastuzumab-qyyp, biosimilar, (trazimera), 10 mg - **Q5113** - Injection, trastuzumab-pkrb, biosimilar, (Herzuma), 10 mg - **Q5114** - Injection, Trastuzumab-dkst, biosimilar, (Ogivri), 10 mg - **Q5102** - Injection, infliximab, biosimilar, 10 mg - **Q5115** - Injection, rituximab-abbs, biosimilar, (Truxima), 10 mg

Frequently asked questions

In 10 mg increments. For example, if 500 mg was infused, bill 50 units of Q5117.

It's normal to feel pain and discomfort in the injection site. Taking this injection might make the patient nauseous, though. The more severe but rare complications that could happen include congestive heart failure, allergic reactions, and injection site infections.

Some patients will notice the benefits in a few weeks. Some might take a few months.