KEYTRUDA FOR ADVANCED HER2-NEGATIVE GASTRIC OR GEJ ADENOCARCINOMA

The following codes as of September 2023 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, in combination with fluoropyrimidine- and platinum-containing chemotherapy, is indicated for the first-line treatment of adults with locally advanced unresectable or metastatic HER2-negative gastric or gastroesophageal junction (GEJ) adenocarcinoma.

FDA-Approved Dosing

The FDA-approved dose of KEYTRUDA is either 200 mg administered after dilution as an intravenous infusion over 30 minutes every 3 weeks or 400 mg administered after dilution as an intravenous infusion over 30 minutes every 6 weeks, until disease progression, unacceptable toxicity, or up to 24 months.

When administering KEYTRUDA in combination with chemotherapy, administer KEYTRUDA prior to chemotherapy when given on the same day. Refer to the Prescribing Information for the chemotherapy agents administered in combination with KEYTRUDA for recommended dosing information, as appropriate.

See full Prescribing Information for preparation and administration instructions and dosage modifications for adverse reactions.

Possible relevant diagnosis codes for gastric or GEJ cancer

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

 

C16: Malignant Neoplasm of Stomach4

NOTE: ICD-10 code C16.0 includes malignant neoplasm of gastroesophageal junction

The C16 series:

  • Excludes: malignant carcinoid tumor of the stomach
ICD-10-CM CODE DESCRIPTOR
C16.0 Malignant neoplasm of cardia
  • Malignant neoplasm of cardiac orifice
  • Malignant neoplasm of cardio-esophageal junction
  • Malignant neoplasm of esophagus and stomach
  • Malignant neoplasm of gastro-esophageal junction
C16.1 Malignant neoplasm of fundus of stomach
C16.2 Malignant neoplasm of body of stomach
C16.3 Malignant neoplasm of pyloric antrum
  • Malignant neoplasm of gastric antrum
C16.4 Malignant neoplasm of pylorus
  • Malignant neoplasm of prepylorus
  • Malignant neoplasm of pyloric canal
C16.5 Malignant neoplasm of lesser curvature of stomach, unspecified
  • Malignant neoplasm of lesser curvature of stomach, not classifiable to C16.1-C16.4
C16.6 Malignant neoplasm of greater curvature of stomach, unspecified
  • Malignant neoplasm of greater curvature of stomach, not classifiable to C16.0-C16.4
C16.8 Malignant neoplasm of overlapping sites of stomach
C16.9 Malignant neoplasm of stomach, unspecified
  • Gastric cancer not otherwise specified