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Xiaflex....ugh. HELP PLEASE!!!

  1. #1
    Location
    Piedmont Area Coders, VA
    Posts
    51
    Unhappy Xiaflex....ugh. HELP PLEASE!!!
    Medical Coding Books
    Hi All!

    Our Hand Center has been using Xiaflex for the past year, and we are STILL having issues with diff carriers wanting diff CPT's submitted. Is anyone having luck getting Aetna to pay for the injection?

    I would LOVE to know how others are billing for Xiaflex, and if payer (other than MCR) is actually covering..... The Drug Rep did a GREAT job of selling it to my docs, but so far the reimbursement is NOT delivering

    Any other Hand Center coders, or others with Xiaflex exp. willing to talk? We can chat via private emails if you don't feel comfortable with the open forum discussion....

    Thanks!!

    Dawn
    ddm9s@virginia.edu
    dc
    RHIT,CPC

  2. #2
    Location
    albuquerque
    Posts
    93
    Default
    what codes are you using?
    Angelica Stephens RHIT, CPMA, COSC, CCS-P, CPC, COC.
    Albuquerque, NM

  3. #3
    Location
    Piedmont Area Coders, VA
    Posts
    51
    Default
    For MCR: 20550 day 1, 9921x day 2

    Then come the versions:
    26989 day 1, 99024 day 2
    20550 day 1, 26989 day 2

    I've seen others try
    20550 day 1, 26340-52 day 2 (52 b/c local anesthesia ONLY)


    the Rep wants us to bill (same BIG fee both days...)
    26989 day 1, 26989 day 2
    dc
    RHIT,CPC

  4. Default
    Hi,
    Billing for Xiaflex™ (collagenase clostridium histolyticum)
    XiaflexTM is only indicated for Dupuytren's contractures, ICD-9 code 728.6 (Contracture of palmar fascia).
    Day 1
    Effective 11/15/2010 and after Providers are instructed to bill CPT code 20550 [Injection(s); single tendon sheath, or ligament, aponeurosis (e.g., plantar “fascia”)], in addition to the drug. Prior to 11/15/2010 providers were instructed to bill CPT code 26989 (Unlisted procedure, hands or fingers).
    Day 2
    Providers are instructed to bill CPT 99213 which will represent the stretching of the cord and local anesthesia or analgesia and CPT 29130 for the splint application.
    Billing for collagenase clostridium histolyticum (Xiaflex™)
    01/01/2011 and after; can use code J0775 Injection, collagenase, clostridium histolyticum, 0.01 mg

    Regards,
    LMohan

  5. #5
    Location
    Piedmont Area Coders, VA
    Posts
    51
    Default
    That reads like an official policy. What carrier released that?

    That is what we use for *MEDICARE ONLY* If you are using that code set across the board for all your carriers you are losing revenue.

    Cigna and Aetna have released coverage policies for Xiaflex using different coding guidance and CPT codes.
    My questions was, of those who are following the coverage policy codes, are you seeing ANY reimbursement?
    dc
    RHIT,CPC

  6. #6
    Default
    Clinical Policy Bulletin from Aetna's website.

    http://www.aetna.com/cpb/medical/data/800_899/0800.html

  7. #7
    Default
    Our Xiaflex rep helps us out with all our coding (we are just starting to use it) to make sure that the claim will go through clean and even helps with the prior auth. I suggest calling your local Xiaflex rep.. They are a great resource and know the ins and outs of the insurances

    PS. also make sure you are using 90 in the quantity. as the code is for each 0.01 mg and the injection is 0.90 mg
    Tina Wosmek CPC, COSC

  8. #8
    Default
    Sorry I re-read and saw that your rep gave you that info.,
    Here is what ours gave us. We got a whole binder of stuff..Make sure of course you get your prior authorization--you wont get reimbursement without them.

    We are told to use 20550 with J0775 x 90. (make sure to complete your box 19 with drug name dosage and ndc--to be safe)

    next day use 26989 or use E&M and 29130 (dependant on carrier preference)

    Hope that helps.

    I am assuming that you are in a clinical setting.
    Tina Wosmek CPC, COSC

  9. #9
    Location
    Piedmont Area Coders, VA
    Posts
    51
    Default
    Thanks Tina, for responding. And yes, I am in a clinical setting!
    dc
    RHIT,CPC

  10. #10
    Location
    albuquerque
    Posts
    93
    Default check this out
    Angelica Stephens RHIT, CPMA, COSC, CCS-P, CPC, COC.
    Albuquerque, NM

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