Take advantage of this strategy for catching diagnosis code requirements. Considering how often CMS's Provenge coding rules have changed, you need to have a game plan for staying up to date. One place to start is the manufacturer's website, says Lisa S. Martin, CPC, CIMC, CPC-I, chargemaster specialist for OSF Healthcare System in Peoria, Ill. "Take advantage of their specialized knowledge and assistance when offered, especially when an office or facility initially starts using the product," Martin says. You'll find the website at www.provengereimbursement.com/. Of course you should check what the manufacturer says against payer policies, but the manufacturer site offers a good starting point. You can search your payer's site, or the Provenge reimbursement website offers links to "state-specific coverage information, and there is an external link to the Medicare NCD [National Coverage Determination] from their website, which also contains very specific information," says Martin. Provenge policies are indeed very specific, so reading the national and local policies in full is important. For instance, Provenge has both primary and secondary diagnosis coding requirements for on-label use, Martin notes. If you leave off one of the required codes, you can expect reimbursement issues, she adds. Example: (To see the J1 Palmetto GBA article in full, head to www.palmettogba.com/medicare. In the search box, choose J1 Part B and enter the article title: "New HCPCS Code for Provenge." The results page will show the link for that article.) Billing system strategy: