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Urology Coding Alert

Coding 96400 for Lupron Administration? Not Anymore

- Published on Sat, Jan 01, 2005
CMS wants you to meet 3 new G-codes - and reacquaint yourself with an old CPT Code - to report injections in 2005 If you code 90780, 90782 or 96400 for injection administration for Medicare patients in the New Year, you're likely to receive a pile of denials. That's because Medicare has introduced 3 new temporary G-codes to take their place for 2005.

You'll see slightly less reimbursement from the G-codes than you did from the CPT Codes - but you will be able to bill them with E/M services "with the expectation of full payment for both," says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook, New York. Get to Know These 3 G-Codes The Medicare Modernization Act (MMA) mandated an examination of drug administration codes to make sure they adequately reflect the work involved in the procedures. A Drug Administration Workgroup, made up of representatives from various specialties, including urology, suggested several coding changes. The CPT Editorial Panel accepted 12 new and 14 revised codes for drug infusion and administration - but they won't appear in CPT books until 2006. As a stopgap measure, CMS decided to use G-codes in 2005 for physicians billing Medicare for drug infusion and administration.

Urology coders, keep your eyes open for these new codes for use in the office: For Zometa injections:

Old code: 90780 - Intravenous infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour
2005 code: G0347 - Intravenous infusion, for therapy/diagnosis, initial, up to one hour For therapeutic or diagnostic injections, such as Depo-Testosterone:

Old code: 90782 - Therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular
2005 code: G0351 - Therapeutic or diagnostic injection.
For Lupron, Zoladex or other anti-neoplastic injections:
Old code: 96400 - Chemotherapy administration, subcutaneous or intramuscular, with or without local anesthesia

2005 code: G0356 - Hormonal, anti-neoplastic, subcutaneous or intramuscular injection. In the 2005 physicians' fee schedule, codes 90780, 90782 and 96400 are listed with a status code of "I." That status code indicates that the CPT codes are no longer valid for Medicare purposes, says Ann Helfenbein, CCS-P, coding specialist for the urology division of the Texas Tech University Health Sciences Center in Amarillo. Medicare uses other codes - in this case, the new G-codes - to report and pay services marked with an "I" status code.

Upside: Previously, 90782 had a "T" status code, which meant that Medicare would only pay for it if there were no other services payable under the physician fee schedule billed on the same date by the same provider.  

However, all the new G codes (including G0351, which replaces 90782) have an "A" status indicator - meaning you can always bill [...]

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