Oncology & Hematology Coding Alert

Question: An answer to a reader question in the May 2004 Oncology Coding Alert advised coders to report therapeutic infusion code 90782 for Zoladex administration. But I thought Zoladex was a chemotherapy drug, so shouldn't we use a chemo administration code (96400-96549)? Virginia Subscriber Answer: Although oncologists use Zoladex to help stop the growth of cancer cells, the drug is a hormonal, not chemotherapy, drug. Therefore, unless your carrier requires a different code, you should report 90782 (Therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular).

Previously, carriers recommended that you report Zoladex administration with either 96400 (Chemotherapy administration, subcutaneous or intramuscular, with or without local anesthesia) or 90782, but now most payers require 90782. For example, in December 2003, Noridian Administrative Services recommended that providers use 90782 when billing for Zoladex administration. - Answers to Reader Questions and You Be the Coder were provided by Linda L. Lively, MHA, CCS-P, RCC, CHBME, founder and CEO of American Medical Accounting and Consulting in Marietta, Ga.; and Margaret M. Hickey, MS, MSN, RN, OCN, CORLN, an independent coding consultant based in New Orleans.