Wiki Which way is correct?

[Tiffanynora]

Question about diagnosis for patients that are seen in infusion clinics for the "Prolia (denosumab)" injection.
I am being instructed to code Z51.15 - Encounter for antineoplastic immunotherapy as the Primary Diagnosis following the providers diagnosis (M81.0) for these encounters for when the patient is seen for their injection.

Should I be including the "Z51.12" DX code?
I am not finding any information to support billing this way.

My sources of information: https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=52399&ver=50&=
https://www.proliahcp.com/-/media/T...162_82995_Prolia-Billing-and-Coding-Guide.pdf

 

[sls314]

Who is instructing you to use the Z51.12? The provider or the payer? Does the patient also have a neoplastic condition or are they strictly being treated for age-related osteoporosis?

I would not use a Z51 code for a Prolia injection for age-related osteoporosis. The code book specifically says for a nonneoplastic condition to code to the condition.

To the best of my knowledge, we don't use a Z51 code for Prolia at my workplace. (That being said, I'm not the one who codes those accounts - I work specifically with the radiation therapy.)

If a specific payer was requiring it, we might bill it for that payer, but not across all payers.

 

[rachaelwilleford]

I used to code for the prolia injections, and I concur with everything that is in the above response. Prolia is not antineoplastic.