Oncology & Hematology Coding Alert
Let Purpose Determine Drug Administration Code Choice
Question: When a patient is receiving Lupron injections as part of their treatment for prostate cancer, should they be billed as 96402? We are currently billing them as 96372, which I understand should be used in the treatment of a noncancer patient. AAPC Forum Participant Answer: You are correct in saying that 96402 (Chemotherapy administration, subcutaneous or intramuscular; hormonal anti-neoplastic) should be used to document Lupron injection administration in a cancer patient, and that 96372 (Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular) should be used for injection administration for noncancer patients. This means you should use 96402 in conjunction with J1950 (Injection, leuprolide acetate (for depot suspension), per 3.75 mg) for Lupron injections intended for chemotherapy. However, note that some payers will not allow you to use C61 (Malignant neoplasm of prostate) as a medically necessary cancer diagnosis in combination with the two codes. See, for example, Palmetto GBA’s Local Coverage Determination (LCD) A59160.
Related Articles
Oncology & Hematology Coding Alert
- Genetic Testing:
Get the Answers to Your Frequently Asked Genetic Testing Questions
Here’s how to make your way through the CPT® molecular pathology code set. “The genetic [...] - Coding Quiz:
Correctly Code These Scenarios, Ace This Cancer Fatigue Quiz
Understand etiology and synonyms for accurate dx documentation. Cancer and fatigue go hand-in-hand, which means [...] - Reimbursement:
Find Your Way Through the Prior Authorization Maze
Hint: Don’t forget to keep track of denials so you can troubleshoot your processes. Healthcare [...] - Coding Quiz Answers:
Check Your Answers to Our Cancer Fatigue Coding Quiz
Don’t forget to read inclusion terms carefully. Once you’ve answered the quiz questions on page [...] - You Be the Coder:
Use This Tree for Correct Screening Mammography Coding
Question: If a patient is having a mammogram for a screening, you use the Z12.31. If [...] - Reader Questions:
Assign Codes and Responsibility for Code Choices
Question: Who is responsible for the final diagnosis used for an office/ outpatient evaluation and management [...] - Reader Questions:
Read Guidelines Closely for Breast Exam Documentation
Question: I have a radiology report stating the provider captured “ultrasound images of the patient’s right [...] - Reader Questions:
Let Purpose Determine Drug Administration Code Choice
Question: When a patient is receiving Lupron injections as part of their treatment for prostate cancer, [...]
