Coping with Coding has been developed to provide you with educational articles focusing on common coding questions and issues facing many Urologists. 

Coding Injections
by Michael A. Ferragamo MD, FACS

On January 1, 2006, the injections codes used by most urologists in their office were changed from alpha-numeric to a purely numeric CPT codes. CPT code 96402, hormonal therapy, antineoplastic, used for an IM. or SC. injection of Lupron/Eligard, Zoladex, Plenaxis, or Trelstar, now has replaced CPT code G0356. 96402 also now bundles CPT code 99211, and this edit is not unbundled with any modifier. This means that a nurse can no longer bill for her service using 99211 when she performs an E/M service at the time she also administers the above hormone treatments. She should only bill for the injection and a J code for the medication. However, if a urologist, a physician, PA, or a nurse practitioner, NP, provides an E/M service at the same encounter during which the above injection is administered, an E/M service (such as an established office visit, 99212 to 99215), may also be billed and paid by Medicare and other insurance carriers. But remember to be paid one must add modifier -25 to the E/M service.

If the urologist, PA, or NP questions the patient concerning any ill effects, problems, or adverse reactions to the previous injection and documents these questions and inquiries and then from these responses makes a decision to administer the next dose, these inquiries and decision making warrant at least a level 2, 99212, E/M service charge. If a more extensive E/M service is provided, a higher charge should be made.The J codes for the above hormone therapies are Lupron/Eligard J9217, Zoladex J9202, Plenaxis J0128, and Trelstar J3315. Private carries are also using CPT code 96402 for the 2006 fiscal year and appear also to be following the above polices.

CPT code 90772, therapeutic/prophylactic injection, im/sc, is now used for injections such as for the administration of androgens, Epogen, and now also including antibiotics.This code replaces codes G0351, 90782, and 90788. Again 99211 is not a billable E/M service when used with this CPT code as stated above. However, you may bill both the injection code and the following E/M codes with modifier -25...99212-99215(-25) or 99202-99295(25). Some J drug codes payable by Medicare and some private carriers are: Testosterone cypionate, 200 mg J1080, Testosterone enanthate, 100mg J3120, and gentamycin, up to 80 mg. J1580.

CPT code 90765, iv infusion for therapy/diagnosis up to one hour, used for the intravenous infusion of Zometa, Zoledronic acid, replaces CPT code G0347 for 2006. New York State indications for the use of this drug include metastatic carcinoma of the prostate, ICD-9 codes 198.5 and 185 and osteoporosis, induced by hormonal treatment of carcinoma, 733.09 and 185. Again as for the above CPT codes, 99211 is not a payable service along with 90765, but 99212-99215(-25) are billable and payable services with 90765. The HCPCS code for Zometa is J3487 per 1 mg. The standard dose for Zometa is 4 mg, so add 4 to the units column, 24G, on the 1500 form when submitting for a course of Zometa therapy and bill the one unit charge x 4.

Further questions concerning the above or for any coding questions or difficulties should be directed to:

Michael A. Ferragamo MD, FASC
Tele: 516-741-0118
E-mail: Liqgold2@AOL..COM
Fax: 516-294-4736

The help is free and provided by the New York State Urological Society as a valued service for its members