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Thread: Coding Zometa

  1. #1
    Join Date
    Apr 2007
    Lakeland, FL

    Question Coding Zometa

    AAPC: Back to School
    Can I please get some assistance from you Oncology experts!!! When billing Zometa J0387, do you have to submit a dual diagnosis?

    One person tells me yes, another tells me no, and I cannot find anything in the CMS guidelines to assist me....

    Please help

  2. #2


    As far as I know, 2 dx codes are not required. You need a dx to support the use of the drug. I would assume it would also depend on which insurance carrier you are billing. Are you getting denials?

  3. #3
    Join Date
    Apr 2007

    Default Zometa j3487

    My payers want to see the primary dx (eg:cancer code) and then the dx to support medical necessity (eg: 198.5 bone mets), so yes we use the two codes on all or claims.

    I hope this helps.

    C.Shaunta Brake,CPC

  4. #4
    Join Date
    Apr 2007
    Columbia, MO


    Zometa is given for bone mets 198.5 and when you list a metastatic ca you must indicate the primary site with anothe code which can be active, hx of, or unknown.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5

    Default Llucas

    Hello I bill for Zometa everyday.

    You would need the Zometa HCPCS code and and administration code. You would need a Diagnosis code to support the reason why the Zometa is being given and you would link the DX code to the Zometa and the administration of the zometa. There are several codes that support the medical neccessity of Zometa. The main one is 198.5 Bone mets but there could also be 203.00- multiple myeloma, 733.00- Osterporis.

    Hope this helps.


  6. #6
    Join Date
    Apr 2007
    Bettendorf, Iowa


    There are primarily 2 reasons we give zometa. bone mets 198.5 or myeloma 203.00. if its bone mets we bill 198.5 + the cancer dx. if its myeloma we bill only the 203.00
    Ruth Long CPC,CHONC

  7. #7


    What if Zometa is done as the only treatment and it's an IVP?

    Would I use 96374?

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