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Aloxi

L

librak1

Networker
Messages
31
Location
Ft Wayne, IN
We are seeing more denials in our office for aloxi. Since there is no LCD for J2469, I would like to know what diagnosis others are using and are getting paid. Thanks
 
Many payers require dx listed in specific order. And some payers are even requiring pre-cert specifically for anti emetics, especially Aloxi since its a little more pricey. Not all payers have a policy on anti emetics so its best to call and ask.

Aloxi is permitted at the time of encounter for chemo as part of the protocol for certain chemo drugs that are the highest risk for inducing nausea/vomiting. NCCN compendium guidelines have palonosetron listed, which is one of the compendia followed by Medicare. This supports the use of aloxi for those high risk biologics. Our carrier requires we code in this order:

787.xx for nausea
xxx.xx for the appropriate disease dx
V58.11 for chemo encounter

Of course as always this is physician ordered, reviewed, and approved
 
Our carrier also requires specific diagnosis ordering for Aloxi (J2469).
787.xx - nausea
V58.11 - encounter for chemotherapy
xxx.xx - disease Dx

The Aloxi is covered when administered & billed along with highly emetogenic chemotherapies. If you are absolutely unable to find an LCD, the NCCN guidelines are followed by most payers and you should be able to sight their reccomendation. Good luck.
 
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