KEYTRUDA FOR LOCALLY RECURRENT UNRESECTABLE OR METASTATIC TNBC
Download possible relevant diagnosis codes for TNBC

The following codes as of February 2021 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 chemotherapy, is indicated for the treatment of patients with locally recurrent unresectable or metastatic triple-negative breast cancer (TNBC) whose tumors express PD-L1 (CPS ≥10) as determined by an FDA-approved test. This indication is approved under accelerated approval based on progression-free survival. 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 with locally recurrent unresectable or metastatic TNBC is either 200 mg administered as an intravenous infusion over 30 minutes every 3 weeks or 400 mg administered as an intravenous infusion over 30 minutes every 6 weeks, until disease progression, unacceptable toxicity, or up to 24 months.

KEYTRUDA is indicated for use at an additional recommended dosage of 400 mg every 6 weeks for all approved adult indications. This indication is approved under accelerated approval based on pharmacokinetic data, the relationship of exposure to efficacy, and the relationship of exposure to safety. Continued approval for this dosing may be contingent upon verification and description of clinical benefit in the confirmatory trials.

Possible relevant diagnosis codes for TNBC

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

 

C50.01: Malignant neoplasm of nipple and areola, female5

    ICD-10-CM CODE DESCRIPTOR
    C50.011 Malignant neoplasm of nipple and areola, right female breast
    C50.012 Malignant neoplasm of nipple and areola, left female breast
    C50.019 Malignant neoplasm of nipple and areola, unspecified female breast

C50.02: Malignant neoplasm of nipple and areola, male5

ICD-10-CM CODE DESCRIPTOR
C50.021 Malignant neoplasm of nipple and areola, right male breast
C50.022 Malignant neoplasm of nipple and areola, left male breast
C50.029 Malignant neoplasm of nipple and areola, unspecified male breast

C50.11: Malignant neoplasm of central portion of breast, female5

ICD-10-CM CODE DESCRIPTOR
C50.111 Malignant neoplasm of central portion of right female breast
C50.112 Malignant neoplasm of central portion of left female breast
C50.119 Malignant neoplasm of central portion of unspecified female breast

C50.12: Malignant neoplasm of central portion of breast, male5

ICD-10-CM CODE DESCRIPTOR
C50.121 Malignant neoplasm of central portion of right male breast
C50.122 Malignant neoplasm of central portion of left male breast
C50.129 Malignant neoplasm of central portion of unspecified male breast

C50.21: Malignant neoplasm of upper-inner quadrant of breast, female5

ICD-10-CM CODE DESCRIPTOR
C50.211 Malignant neoplasm of upper-inner quadrant of right female breast
C50.212 Malignant neoplasm of upper-inner quadrant of left female breast
C50.219 Malignant neoplasm of upper-inner quadrant of unspecified female breast

C50.22: Malignant neoplasm of upper-inner quadrant of breast, male5

ICD-10-CM CODE DESCRIPTOR
C50.221 Malignant neoplasm of upper-inner quadrant of right male breast
C50.222 Malignant neoplasm of upper-inner quadrant of left male breast
C50.229 Malignant neoplasm of upper-inner quadrant of unspecified male breast

C50.31: Malignant neoplasm of lower-inner quadrant of breast, female5

ICD-10-CM CODE DESCRIPTOR
C50.311 Malignant neoplasm of lower-inner quadrant of right female breast
C50.312 Malignant neoplasm of lower-inner quadrant of left female breast
C50.319 Malignant neoplasm of lower-inner quadrant of unspecified female breast

C50.32: Malignant neoplasm of lower-inner quadrant of breast, male5

ICD-10-CM CODE DESCRIPTOR
C50.321 Malignant neoplasm of lower-inner quadrant of right male breast
C50.322 Malignant neoplasm of lower-inner quadrant of left male breast
C50.329 Malignant neoplasm of lower-inner quadrant of unspecified male breast

C50.41: Malignant neoplasm of upper-outer quadrant of breast, female5

ICD-10-CM CODE DESCRIPTOR
C50.411 Malignant neoplasm of upper-outer quadrant of right female breast
C50.412 Malignant neoplasm of upper-outer quadrant of left female breast
C50.419 Malignant neoplasm of upper-outer quadrant of unspecified female breast

C50.42: Malignant neoplasm of upper-outer quadrant of breast, male5

ICD-10-CM CODE DESCRIPTOR
C50.421 Malignant neoplasm of upper-outer quadrant of right male breast
C50.422 Malignant neoplasm of upper-outer quadrant of left male breast
C50.429 Malignant neoplasm of upper-outer quadrant of unspecified male breast

C50.51: Malignant neoplasm of lower-outer quadrant of breast, female5

ICD-10-CM CODE DESCRIPTOR
C50.511 Malignant neoplasm of lower-outer quadrant of right female breast
C50.512 Malignant neoplasm of lower-outer quadrant of left female breast
C50.519 Malignant neoplasm of lower-outer quadrant of unspecified female breast

C50.52: Malignant neoplasm of lower-outer quadrant of breast, male5

ICD-10-CM CODE DESCRIPTOR
C50.521 Malignant neoplasm of lower-outer quadrant of right male breast
C50.522 Malignant neoplasm of lower-outer quadrant of left male breast
C50.529 Malignant neoplasm of lower-outer quadrant of unspecified male breast

C50.61: Malignant neoplasm of axillary tail of breast, female5

ICD-10-CM CODE DESCRIPTOR
C50.611 Malignant neoplasm of axillary tail of right female breast
C50.612 Malignant neoplasm of axillary tail of left female breast
C50.619 Malignant neoplasm of axillary tail of unspecified female breast

C50.62: Malignant neoplasm of axillary tail of breast, male5

ICD-10-CM CODE DESCRIPTOR
C50.621 Malignant neoplasm of axillary tail of right male breast
C50.622 Malignant neoplasm of axillary tail of left male breast
C50.629 Malignant neoplasm of axillary tail of unspecified male breast

C50.81: Malignant neoplasm of overlapping sites of breast, female5

ICD-10-CM CODE DESCRIPTOR
C50.811 Malignant neoplasm of overlapping sites of right female breast
C50.812 Malignant neoplasm of overlapping sites of left female breast
C50.819 Malignant neoplasm of overlapping sites of unspecified female breast

C50.82: Malignant neoplasm of overlapping sites of breast, male5

ICD-10-CM CODE DESCRIPTOR
C50.821 Malignant neoplasm of overlapping sites of right male breast
C50.822 Malignant neoplasm of overlapping sites of left male breast
C50.829 Malignant neoplasm of overlapping sites of unspecified male breast

C50.91: Malignant neoplasm of breast of unspecified site, female5

ICD-10-CM CODE DESCRIPTOR
C50.911 Malignant neoplasm of unspecified site of right female breast
C50.912 Malignant neoplasm of unspecified site of left female breast
C50.919 Malignant neoplasm of unspecified site of unspecified female breast

C50.92: Malignant neoplasm of breast of unspecified site, male5

ICD-10-CM CODE DESCRIPTOR
C50.921 Malignant neoplasm of unspecified site of right male breast
C50.922 Malignant neoplasm of unspecified site of left male breast
C50.929 Malignant neoplasm of unspecified site of unspecified male breast