Results 1 to 6 of 6

Reclast

  1. #1
    Default Reclast
    Medical Coding Books
    Our OB/GYN would like to begin using Reclast on patients that have not been diagnosed with osteoporosis or osteopenia but have a high fracture risk.
    I would like something to back this up... anyone have any information you can share with me?
    Vanessa Ramirez, CPC, CHC, CPB
    San Angelo, Texas

  2. #2
    Location
    Tacoma, WA
    Posts
    1,087
    Default
    Quote Originally Posted by vramirez View Post
    Our OB/GYN would like to begin using Reclast on patients that have not been diagnosed with osteoporosis or osteopenia but have a high fracture risk.
    I would like something to back this up... anyone have any information you can share with me?
    It is very difficult to get Reclast authorization even if they have osteoporosis or osteopenia. Most insurance carriers require that the patient has failed all other forms of therapy. Would need to know specific reasoning behind why the doctor wants it for this patient.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  3. #3
    Default Reclast
    In most cases, the patients we pursue reclast in have some sort of intolerance to oral biphosphenates, or have tried them and are not improving on their bone density. We rarely recommend it prior to trying some sort of oral biphosphenate first.
    Vanessa Ramirez, CPC, CHC, CPB
    San Angelo, Texas

  4. #4
    Location
    Tacoma, WA
    Posts
    1,087
    Default
    Quote Originally Posted by vramirez View Post
    In most cases, the patients we pursue reclast in have some sort of intolerance to oral biphosphenates, or have tried them and are not improving on their bone density. We rarely recommend it prior to trying some sort of oral biphosphenate first.
    Right, that is the way most providers do it. From there it just depends on the diagnosis codes for the patient. Most carriers are very specific on the reasons for prescribing Reclast instead of a lesser expensive drug. Each case will be different and you will probably have to pursue them as them arise. My OB/Gyn practice chose not to pursue giving Reclast because of the expense and the difficulty in getting it authorized.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  5. #5
    Question Fracture Risk
    What is dx for fracture risk?
    Vanessa Ramirez, CPC, CHC, CPB
    San Angelo, Texas

  6. #6
    Location
    Tacoma, WA
    Posts
    1,087
    Default
    Quote Originally Posted by vramirez View Post
    What is dx for fracture risk?
    There is no one diagnosis for fracture risk. It is whatever medical problem the patient has that makes them at a high risk for fractures. Usually it is osteoporosis or osteopenia, but some cancers especially bone cancer can put you at higher risk for fractures. Hypercalcemia can also put you at high risk for fractures. That is why I was saying, you may have trouble getting authorizations for Reclast for high fracture risk.....WHY is the patient at high risk for fracture. Then see if that reason is acceptable to the insurance carrier.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

Similar Threads

  1. reclast
    By mtyszko in forum Billing/Reimbursement
    Replies: 11
    Last Post: 01-02-2014, 07:09 PM
  2. Reclast J3488
    By Rgreen0118 in forum OB/GYN
    Replies: 4
    Last Post: 10-11-2011, 02:04 PM
  3. Billing for Reclast
    By creehle in forum Billing/Reimbursement
    Replies: 3
    Last Post: 05-24-2010, 10:08 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.