Urology Coding Alert

Question: Our office had been using the Testopel pellets (75mg) and billing with S0189. Now they are using generic pellets instead of Testopel, which are 87.5 mg each. What are your thoughts on appropriate billing?

New Mexico Subscriber

Answer: Correct billing can depend on the payer to which you are reporting the service. Code S0189 (Testosterone pellet, 75 mg) is only for the billing of 75 mg Testopel pellets. In general, do not bill S0189 for the 87.5 mg pellets. However, Medicare often allows for J3490 (Unclassified drugs) for the generic pellets, and other insurers accept S0189 for either Testopel or a generic substitute. Check with the payer before submitting the claim.

Also note that if you file with J3490, you should include thorough documentation of the medication used, quantity, and reason for it so the payer will understand the service your urologist provided.