Urology Coding Alert

Question: If you use code 96400 with code J9217 for Lupron injections, would code 96400 also be used for Zoladex injections (J9202)?

Minnesota Subscriber

Answer: It would depend on how the payer has classified Zoladex (goserelin acetate). Zoladex is classified in the Physician Drug Reference and the Red Book Topic of Drugs as an antineoplastic used in the treatment for prostate cancer. There are payers who have determined that Zoladex and Lupron are actually hormone therapy.

The reporting of a chemotherapy administration code (e.g., 96400) is inappropriate. These payers have directed that 90782 (IM/subcutaneous injection) be reported for the administration of Zoladex or Lupron. The coder should review payer guidelines to determine the appropriate administration code.

Answers to You Be the Coder and Reader Questions contributed by Ray Painter, MD, a urologist and president of PRS, a coding and reimbursement consulting firm in Denver; Sandy Page, CPC, CCS-P, co-owner, Medical Practices Support Services, a compliance, coding and reimbursement consulting firm in Denver; and Laura Siniscalchi, RHIA, CCS, CCS-P, CPC.