Wiki Lucentis in treating Diabetic Macular Edema

[ddcncirillo@verizon.net]

Recent Medicare LCD guidelines (L25820) dated 9/1/12 has added ICD-9 cm code 362.07 to the "ICD-9 Codes that are Covered" section for ranibizumab (Lucentis) effective on or after 8/10/12. I've billed this drug code J2778 with ICD-9-CM codes 362.07,362.05,250.50 respectively and the claim has been denied as not following LCD guidelines for medically necessary. What have I missed on this revised guideline?

 

[EMACHORRO]

did you use the specific NDC # for the DME lucentis? did you bill 3 units?

 

[pataw514]

lucentis for dme

Lucentis when used fo diabetic macular edema is billbed using 3 units -- the ndc # is 50242-0082-01

 

[whilton]

There was a delay in Medicare updating their system to acknowledge the new coverage for DME. They did not correct the problem until 11/30/2012. So if you have not refiled your claim you may refile it to Medicare for consideration.

 

[torberson1]

Lucentis

Novitas has just updated their system on 02/04/2013 for Lucentis. They have not updated the LCD yet. Only three dx codes are on it the LCD. If you go to the Lucentis website there is a great list of approved dx codes that support medical necessity. Call Novitas and they will reprocess the claims over the phone.