Stop Using 96402 For Lupron Injections In Noridian Patients

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Does your practice treat patients with insurance cover through Noridian? If so, you will need to take note of a new chemotherapy drug administration rule from the Medicare Administrative Contractor (MAC). See to it that you are correctly reporting Lupron injections to stay away from denials.


This will have an effect on practices in Arizona, Utah, North Dakota, South Dakota, Wyoming, and Montana, with Noridian Administrative Services as their MAC.


Be aware of the reason for change


With effect from March 1 this year, you will not be able to use administration code 96402 with some drugs as you have in the past.


As per the information that Noridian first released on May 6, 2010, the preparation and administration of Gonadotropinreleasing hormones (GnRH), also referred to as luteinizing-hormonereleasing hormones (LHRH) doesn't meet the CPT manual requirements of the use of the chemotherapy administration codes


According to a Nordian notice, Medicare takes the use of the chemotherapy administration codes to properly describe the parenteral ...
... administration of the following drugs ONLY:


J1745 Injection Infliximab
Any non-GnRH drug/compound listed in the current HCPCS section 'CHEMOTHERAPY DRUGS J9000-J9999.' Instances of GnRH and analogs include however are not limited to J9217 and J9218."


Turn to code 96372


How it impacts your practice: says Ann Hayden, office manager at Urology Specialists in Phoenix, “I bill 96402 when we give Lupron (J9217, Leuprolide acetate [for depot suspension], 7.5 mg) and Zoladex (J9202, Goserelin acetate implant, per 3.6 mg).


Now you will no longer be able to use 96402 for the administration. In place of chemotherapy drug administration codes 96401- 96549, you should select a code from the 96360-96379 code series.


New way: It seems like Noridian (MAC) will suggest the use of the injection code 96372 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) in place of 96402 for GNRH analogues such as Lupron, Zoladex, and Trelstar.





Here's an instance: A patient steps into your office for a Lupron injection. The urologist makes a clinical assessment through his examination (level-two evaluation & management service) that the patient can continue to get further doses of Lupron. This assessment demands a separate charge.


Earlier you would have gone for 99212-25 for the clinical assessment, 96402 for the Lupron administration and J9217 for the drug. For a Nordian patient, now you would report 99212-25, 96372, and J9217.


For more on this and for other specialty-specific articles to assist your urology coding, stay tuned to a good medical coding resource like Coding Institute.