Question Administration of Hormone as Chemotherapy

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Z51.11 and Z51.12 are used for an encounter for administration of chemotherapy or immunotherapy. What is used when a patient presents for hormone therapy injection that is being used as chemotherapy? It is charged in our system as chemotherapy. In the past I have used Z51.11, and I haven't had any issues, but I wasn't sure if this was the best code choice. What do others use to best represent this? Thanks
 

thomas7331

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What exactly do you mean by 'hormone therapy injection that is being used as chemotherapy'? What is the patient's condition that the injection is being given to treat? Hormone injections are not chemotherapy. There's a code for hormone replacement therapy, Z79.890, if that's the purpose of the injection, but if it's other than that, I would code the condition that's being treated, not code it as a chemotherapy encounter.
 
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What exactly do you mean by 'hormone therapy injection that is being used as chemotherapy'? What is the patient's condition that the injection is being given to treat? Hormone injections are not chemotherapy. There's a code for hormone replacement therapy, Z79.890, if that's the purpose of the injection, but if it's other than that, I would code the condition that's being treated, not code it as a chemotherapy encounter.
Breast cancer, prostate cancer, etc.
 

thomas7331

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Breast cancer, prostate cancer, etc.
If those are the conditions being treated with hormones, then I would use those as the diagnosis for the injections. I could be mistaken, but to the best of my knowledge, hormone therapy is not a form of chemotherapy, and I'm not aware of any coding guidance that says it should be coded as such.
 
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If those are the conditions being treated with hormones, then I would use those as the diagnosis for the injections. I could be mistaken, but to the best of my knowledge, hormone therapy is not a form of chemotherapy, and I'm not aware of any coding guidance that says it should be coded as such.
Okay, thanks, and the Z79.890 is not needed either, correct?
 

trarut

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Are you sure that the hormone injection is for cancer treatment? Based on the conditions you listed, it sounds like it's likely Lupron injections - which are given for hormone suppression not supplementation. The drug is used in hormone sensitive disease to stop the body from producing the hormone that is feeding the cancer. We use Z51.11 on these type of injections.
 
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Are you sure that the hormone injection is for cancer treatment? Based on the conditions you listed, it sounds like it's likely Lupron injections - which are given for hormone suppression not supplementation. The drug is used in hormone sensitive disease to stop the body from producing the hormone that is feeding the cancer. We use Z51.11 on these type of injections.
I have seen Lupron used, also one of the injections I commonly see is Falsodex. The treatment plans don't specify what they are using the drug for specifically. The patients do have a current cancer diagnosis.
 

trarut

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I apologize for the delay - It's been a crazy few weeks and I haven't had a chance to log back in. If your patients have a cancer diagnosis, it's highly unlikely they're getting hormone replacement. As I said, the goal is usually to suppress hormone production because the cancer is using the hormone to grow so go with your cancer diagnosis codes + Z51 code as applicable. And avoid the code for hormone replacement therapy unless your physician specifically documents it that way :) Happy New Year!
 

rachaelwilleford

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Faslodex is considered a chemotherapy drug with the administration code 96402. However Lupron is considered a supportive drug, not chemotherapy, because of the class of drug. Administration code is dependent on payer, as some want the chemo admin code and some don't. Most of the hormone drugs that are used to treat cancer are actually oral. They can be given as adjuvant treatment or preventative treatment (aromatase inhibitors for example). None of these drugs are considered hormone replacement therapy, as has been mentioned above, they are being used for suppression rather than supplementation.
 
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I apologize for the delay - It's been a crazy few weeks and I haven't had a chance to log back in. If your patients have a cancer diagnosis, it's highly unlikely they're getting hormone replacement. As I said, the goal is usually to suppress hormone production because the cancer is using the hormone to grow so go with your cancer diagnosis codes + Z51 code as applicable. And avoid the code for hormone replacement therapy unless your physician specifically documents it that way :) Happy New Year!
So you are saying that it is okay to use Z51.11 in these circumstances? What kind of medical documentation is needed to support this?
 
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Faslodex is considered a chemotherapy drug with the administration code 96402. However Lupron is considered a supportive drug, not chemotherapy, because of the class of drug. Administration code is dependent on payer, as some want the chemo admin code and some don't. Most of the hormone drugs that are used to treat cancer are actually oral. They can be given as adjuvant treatment or preventative treatment (aromatase inhibitors for example). None of these drugs are considered hormone replacement therapy, as has been mentioned above, they are being used for suppression rather than supplementation.
Yes these are being used for cancer purposes. I was just trying to figure out if I should be using the Z51.11 when they come in for administration of these drugs, of if I should just use the cancer codes
 
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