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.
Oncology & Hematology Coding Alert
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Let Purpose Determine Drug Administration Code Choice
Question: When a patient is receiving Lupron injections as part of their treatment for prostate cancer, [...]
