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Correct Coding for Lupron Depot Administration
By Sally Roland, MS, RHIA, CPC
Lupron is a synthetic version of the naturally occurring gonadotropin-releasing hormone. It suppresses the shedding of the endometrium (lining of the uterus) during menstruation and is used to treat endometriosis, a condition in which cells from the endometrium grow outside of the uterus. Endometriosis causes painful growths to form around the outside of the uterus, the fallopian tubes, and the ovaries.
Two forms of Lupron—Lupron Depot 3.75 and 11.25—are prescribed to relieve the pain of endometriosis and shrink the growths. (The hormonal medication norethindrone acetate is often added to the regimen.) Three other forms of Lupron—Lupron Depot 7.5, 22.5, and 30—are prescribed to relieve the symptoms of advanced prostate cancer.
The first two forms of Lupron are also used before surgery, along with iron, to treat anemia caused by fibroids (tumors) in the uterus when iron alone is not effective. Some doctors also prescribe Lupron for infertility and early puberty.
Recommended Dosages for Lupron Depot
• Lupron Depot 3.75: For endometriosis, a single intramuscular injection is given once per month. Norethindrone may be included in the treatment regimen. Treatment lasts six months. One additional six-month course of treatment may be given, provided norethindrone is included in the second regimen. For anemia due to uterine fibroids, the same dose is given once per month for up to three months.
• Lupron Depot 7.5: For prostate cancer, a single injection is given once per month.
• Lupron Depot 11.25: For endometriosis, a single injection is given every three months. Norethindrone may be included in the treatment regimen. Treatment lasts six months. One additional six-month course of treatment may be given, provided norethindrone is included in the second regimen. For anemia due to fibroids, the usual treatment is a single injection.
• Lupron Depot 22.5: For prostate cancer, a single injection is given every three months.
• Lupron Depot 30: For prostate cancer, a single injection is given every four months.
HCPCS for Lupron Depot Injectable
J1950 Injection, leuprolide acetate (for depot suspension), per 3.75 mg
CPT- 4
Description
Applicable ICD-9-CM Diagnoses
96372
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular
218.0-218.2 Uterine leiomyoma
218.9 Uterine leiomyoma, unspecified
617.0-617.6 Endometriosis
617.8-617.9 Endometriosis of other specified sites; Endometriosis, site unspecified
96402*
Chemotherapy administration, subcutaneous or intramuscular; hormonal antineoplastic
174.0-174.6 Malignant neoplasm of female breast
174.8-174.9 Other specified sites of female breast; Breast (female) unspecified
175.0 175.9 Malignant neoplasm of male breast
V10.3 History of malignant neoplasm breast
The table above was created from information from WPS Health Insurance Medicare Local Coverage Determination.
*Hospitals reporting for the Outpatient Prospective Payment System should report Q0083 instead of 96402.
— Sally Roland, MS, RHIA, CPC, is compliance coordinator at Methodist Physicians Clinic in Omaha, Neb.
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