Wiki Billing J0897 with J9250

[dbouton]

We have a patient that comes in once a week for Methotrexate injection for Rheumatoid Arthritis and she gets Prolia every 6 months for Osteoporosis. The patient wants to come in the same day she gets her Methotrexate for her Prolia injection. I'm a little apprehensive about billing these two together (fear of denial). I would like to know others thoughts about doing the same day or should I just have the patient come in on a different day from Methotrexate injection?

 

[thomas7331]

When and whether a drug should be given is a physician's decision based on a patient's medical needs and shouldn't be changed due to reimbursement considerations.

That said, why are you concerned about of a denial? It's very common for patients to receive multiple drug infusions at the same encounter - I don't know of any reason that this would be denied. If the physician orders both drugs to be administered on the same day, then that's what should be done.

 

[trarut]

Agree with Thomas. If there's no medical reason such as drug interaction that would prevent them from being given together, I don't see any reason you would get a denial. I'm not clinical so I'm going to trust my physician knows if two drugs shouldn't be administered on the same day. Personally, I'd be looking at the last Prolia injection to make sure I met the frequency/timing guidelines for the payer to ensure the drug isn't denied for being given too soon after the last injection.

 

[rachaelwilleford]

Just have to make sure that the dx are indicated correctly. You shouldn't get a denial. We have patients who receive infusions and prolia injections same day all the time.

 

[dbouton]

Dr. ordered both and Prolia is being given at the correct time. Just doubting myself Thank you all so very much for your help!