Wiki J0897 Prolia

[ammontagano]

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]

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

 

[donna_vig]

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 It's been superseded but no current version yet.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.