BGoldsberry
Contributor
Our MAC in South Carolina recently performed a service specific code review for Neulasta (pegfilgrastim). One of the most common denial reasons is:
The Recommended Protocol Was Not Ordered and/or Followed
We always administer Neulasta the day after a patient's chemo treatment.
My question is this; has anyone received a denial because the documentation doesn't specifically mention the exact time of the chemo treatment in relation to the Neulasta or the injection time is not 24 hours or greater? For instance, if the patient was infused on Tuesday at 11:00 am and received Neulasta at 9:00 am on Wednesday would that cause a denial?
Since Neulasta has introduced the On-Body injector, some sales reps are trying to scare our physicians into using it because it is guaranteed to administer the dose approximately 27 hours after it has been applied and therefore will protect us from the expected increase in claim denials.
We have not considered using the On-Body injector because there seems to be some confusion as to how it should be billed.
Any help would be appreciated.
Thanks!
Here's a link to the MAC results.
http://www.palmettogba.com/palmetto...ce=J11AL&utm_campaign=J11ALs&utm_medium=email
The Recommended Protocol Was Not Ordered and/or Followed
We always administer Neulasta the day after a patient's chemo treatment.
My question is this; has anyone received a denial because the documentation doesn't specifically mention the exact time of the chemo treatment in relation to the Neulasta or the injection time is not 24 hours or greater? For instance, if the patient was infused on Tuesday at 11:00 am and received Neulasta at 9:00 am on Wednesday would that cause a denial?
Since Neulasta has introduced the On-Body injector, some sales reps are trying to scare our physicians into using it because it is guaranteed to administer the dose approximately 27 hours after it has been applied and therefore will protect us from the expected increase in claim denials.
We have not considered using the On-Body injector because there seems to be some confusion as to how it should be billed.
Any help would be appreciated.
Thanks!
Here's a link to the MAC results.
http://www.palmettogba.com/palmetto...ce=J11AL&utm_campaign=J11ALs&utm_medium=email