Is anyone having denial issues with Prolia? The Prolia drug LCD was revised and I am a little confused with the diagnosis combination information that is given for the new revision on this drug, particularily 733.90, v10.3 and v07.52. It is my understanding, according to ICD-9 guidelines, that a patient receiving treatment is considered to have active malignancy. When treatments stops, is excised or removed, then the disease is considered to be history of. If a patient is receiving an aromatase inhibitor it leads me to believe that this is treatment and therefore classifies as active malignancy. I am not sure if this is an error on the LCD or if I am missunderstanding this? Does anyone else agree with my thoughts?
Thanks for any opinions on this!