The following codes as of September 2019 are provided as a reference and may be relevant when billing for KEYTRUDA and its administration. Consult the relevant manual and/or other guidelines for a description of each code to determine the appropriateness of its use and for information on additional codes. Diagnosis codes should be selected only by a health care professional. You are solely responsible for determining the appropriate codes and for any action you take in billing.

When submitting a claim for KEYTRUDA, always verify coding requirements with the relevant payer. Coding requirements may vary by insurer or plan; please refer to the payer-specific policies to understand what may be covered.

Check with the relevant payer regarding guidance on which diagnoses they will recognize and the applicability of secondary codes. Health care professionals are solely responsible for selecting codes that appropriately reflect the patient’s diagnosis, the services rendered, and the applicable payers’ guidelines.

Providers should document the diagnosis with a sufficiently high degree of specificity based on the information available to enable the identification of the most appropriate code. Although CMS has said that an unspecified code may be appropriate in some cases, CMS has advised that you should always code with as much specificity as possible consistent with the clinical documentation.

Merck and its agents make no warranties concerning the accuracy or appropriateness of this information for your particular use given the frequent changes in public and private payer billing. Merck cautions that payer-coding requirements vary and can frequently change, so it is important to regularly check with each payer or, where applicable, the Medicare Administrative Contractor as to payer-specific requirements. The use of this information does not guarantee payment or that any payment received will cover your costs.

Indication

KEYTRUDA is indicated for the treatment of adult and pediatric patients with recurrent locally advanced or metastatic Merkel cell carcinoma (MCC). This indication is approved under accelerated approval based on tumor response rate and durability of response. Continued approval for this indication may be contingent upon verification and description of clinical benefit in the confirmatory trials.

FDA-Approved Dosing

The FDA-approved dose of KEYTRUDA in adults is 200 mg administered as an intravenous infusion over 30 minutes every 3 weeks until disease progression, unacceptable toxicity, or up to 24 months in patients without disease progression.

The FDA-approved dose of KEYTRUDA in pediatric patients is 2 mg/kg (up to a maximum of 200 mg), administered as an intravenous infusion over 30 minutes every 3 weeks until disease progression or unacceptable toxicity, or up to 24 months in patients without disease progression.

Possible relevant diagnosis codes for advanced Merkel cell carcinoma

Learn more about each diagnosis code and descriptor by selecting from the series options below.

 

C4A.1: Merkel Cell Carcinoma of Eyelid, Including Canthus4

ICD-10-CM CODE DESCRIPTOR
C4A.10 Merkel cell carcinoma of unspecified eyelid, including canthus

C4A.11: Merkel Cell Carcinoma of Right Eyelid, Including Canthus4

ICD-10-CM CODE DESCRIPTOR
C4A.111 Merkel cell carcinoma of right upper eyelid, including canthus
C4A.112 Merkel cell carcinoma of right lower eyelid, including canthus

C4A.12: Merkel Cell Carcinoma of Left Eyelid, Including Canthus4

ICD-10-CM CODE DESCRIPTOR
C4A.121 Merkel cell carcinoma of left upper eyelid, including canthus
C4A.122 Merkel cell carcinoma of left lower eyelid, including canthus

C4A.2: Merkel Cell Carcinoma of Ear and External Auricular Canal4

ICD-10-CM CODE DESCRIPTOR
C4A.20 Merkel cell carcinoma of unspecified ear and external auricular canal
C4A.21 Merkel cell carcinoma of right ear and external auricular canal
C4A.22 Merkel cell carcinoma of left ear and external auricular canal

C4A.3: Merkel Cell Carcinoma of Other and Unspecified Parts of Face4

ICD-10-CM CODE DESCRIPTOR
C4A.30 Merkel cell carcinoma of unspecified part of face
C4A.31 Merkel cell carcinoma of nose
C4A.39 Merkel cell carcinoma of other parts of face

C4A.4: Merkel Cell Carcinoma of Scalp and Neck4

ICD-10-CM CODE DESCRIPTOR
C4A.4 Merkel cell carcinoma of scalp and neck

C4A.5: Merkel Cell Carcinoma of Trunk4

The C4A.5 series excludes malignant neoplasm of anus NOS and malignant neoplasm of scrotum

ICD-10-CM CODE DESCRIPTOR
C4A.51 Merkel cell carcinoma of anal skin
C4A.52 Merkel cell carcinoma of skin of breast
C4A.59 Merkel cell carcinoma of other part of trunk

C4A.6: Merkel Cell Carcinoma of Upper Limb, Including Shoulder4

ICD-10-CM CODE DESCRIPTOR
C4A.60 Merkel cell carcinoma of unspecified upper limb, including shoulder
C4A.61 Merkel cell carcinoma of right upper limb, including shoulder
C4A.62 Merkel cell carcinoma of left upper limb, including shoulder

C4A.7: Merkel Cell Carcinoma of Lower Limb, Including Hip4

ICD-10-CM CODE DESCRIPTOR
C4A.70 Merkel cell carcinoma of unspecified lower limb, including hip
C4A.71 Merkel cell carcinoma of right lower limb, including hip
C4A.72 Merkel cell carcinoma of left lower limb, including hip

C4A.8: Merkel Cell Carcinoma of Overlapping Sites4

ICD-10-CM CODE DESCRIPTOR
C4A.8 Merkel cell carcinoma of overlapping sites

C4A.9: Merkel Cell Carcinoma, Unspecified4

ICD-10-CM CODE DESCRIPTOR
C4A.9 Merkel cell carcinoma, unspecified