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Aloxi

  1. #1
    Question Aloxi
    Medical Coding Books
    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

  2. #2
    Location
    Central Ga Local/ Macon
    Posts
    11
    Default aloxi injections
    Recheck your LDC lists on Medicare website. There is one there. It is L30033
    Under Drugs & Biologicals, Palonsetron .

  3. #3
    Location
    Columbia, MO
    Posts
    12,843
    Default
    Quote Originally Posted by librak1 View Post
    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
    You need to be using the diagnosis documented by the provider!!!

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
    Location
    Bettendorf, Iowa
    Posts
    133
    Default
    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
    Ruth Long CPC,CHONC
    relong@rccqc.com

  5. #5
    Default
    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.

  6. #6
    Location
    Columbia, MO
    Posts
    12,843
    Default
    V58.11 is a first-listed only dx code so it must be listed first then the cancer dx and then the nausea.

    Debra A. Mitchell, MSPH, CPC-H

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