# J0897 Prolia



## ammontagano (Sep 21, 2012)

We are having trouble getting Prolia injection in this instance:

Patient has prostate Ca with no bone mets.  Per Medicare's article A50361, diagnosis code 185 would need to be billed the one of the following secondary dx:  V58.69 or V66.5

Medicare is denying when we bill this way.  Has anybody else encountered this?


----------



## nkorab (Sep 24, 2012)

The primary DX should be for the bone  disorder/loss  ie: 733.90. then 185 is second.
Hope this helps.
Nancy


----------



## donna_vig (Sep 24, 2012)

FYI-looks like your LCD is currently under revision.  It's been superseded but no current version yet.  I would keep checking it and see what changes affect your services.


----------

