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Prolia the new osteoporosis drug

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    Medical Coding Books
    i am so sorry, i went to take a call and while i was on the phone, i realized i was giving you my opps information..please disregard my know-it-all posts...i was trying to be helpful and instead, i put my foot in my mouth...i'm sure they'll have a real code for you guys one day :-)

  2. #12
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    Thank you all for your input. I appreciate the fact that you gave an opinion.
    Debbie Potts England
    Lyles, TN 37098

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    I work in an oncology clinic and am curious as to what administration code have you been using? We have been using 96401, but was recently told to use 96549- unlisted chemo procedure.. Is that correct?

  4. #14
    Default
    we are not using it for chemo and I was not aware that it was a chemo drug. We are using it for osteoporosis, If I remember correctly. As of now we have not started using it. they are thinking about it. I would like to know what you are using it for. and if you have literature that you can share.
    Debbie Potts England
    Lyles, TN 37098

  5. #15
    Default
    Quote Originally Posted by DebbiePotts View Post
    we are not using it for chemo and I was not aware that it was a chemo drug. We are using it for osteoporosis, If I remember correctly. As of now we have not started using it. they are thinking about it. I would like to know what you are using it for. and if you have literature that you can share.
    The Prolia injection is for osteoporosis. We have some literature that was given to us by the pharmaceutical rep that I will be happy to email to you. If you are interested in it, please provide me your email address and I'll send it to you.

    Thanks!
    Teresa Collins, CPC

  6. #16
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    dpotts@dicksonmd.com
    Thanks I appreciate it.
    Debbie Potts England
    Lyles, TN 37098

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    Our physicians have been using the Xgeva in lieu of Zometa for those patients who have developed bone mets.

  8. #18
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    Anyone have experience billing Prolia to Trailblazer/Medicare?
    We've filed using J3490 & included the 60MG dosage & NDC in the correct loop/segments of the claim. We continue to get denied for "missing/incomplete/invalid procedure code and/or modifier"
    Please any help/insight would be much appreciated.
    Thanks!

  9. #19
    Default
    Yes, we bill Prolia to Trailblazer Medicare using J3490 and put "Prolia subcutaneous 60 mg dose administered " along with the NDC number and have had success in getting the claims paid. I did call our software vendor; however, prior to submitting the claim to be certain that the field where I was entering the detailed info would indeed be in the correct loop. We have given 2 Prolia injections to Trailblazer Medicare patients and have gotten both claims paid.

    I hope this information is of help to you!
    Teresa Collins, CPC

  10. #20
    Default
    Thank you very much for the reply. I think what we've been missing is specifically saying Prolia in our comment. I appreciate the help!
    Hope

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