Wiki Zoladex. Lupron and Eligard

[dsmith03@hotmail.com]

Ok Urology Coders, need some help. I am fairly new to coding. My coworker has been in the office for 40 years, but is not certified. She keeps telling me that we can't give a patient Lupron unless they are grandfathered in (medicare). What does this mean? And where is it documented?

So most of our patients are on Zoladex. We have one patient that can't tolerate Zoladex and have switched him to Eligard. Eligard and Lupron use the same HCPCS code J9217. Will we run into the grandfathered in clause in switching the patient to Eligard?

 

[nminaglia]

We administer Eligard, Lupron, Zoladex and Trelstar to our Medicare patients. I have never had a problem billing and getting reimbursed on any one of them in 6 years.

 

[dsmith03@hotmail.com]

Thank you

 

[pvacanti]

We also administer Eligard, Lupron and Trelstar to Medicare patients and I have never had an issue in getting reimbursed.

 

[bill2doc]

Agreed we bill Lupron 1mo or 3mo J9217 and admin 96402 and get reimbursed Jurisdiction E Part B