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Posted By Danielle Levy on 02-27-2018, 10:31:28 in Ob-Gyn
Melanie,
Our patients come in for a prolia injection ( they bring the drug , we don't supply it ) would the correct coding be 96401 or 96372 for the administration ? Also would we need to report J0897 if we didn't supply it ? thanks
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Posted By Melanie Witt on 02-28-2018, 16:44:35
While Prolia is a monoclonal antibody which might be included for 96401, its administration to does not usually require the highly complex work involved with other drugs of this type such as infliximab, rituximab, alemtuzumb, gemtuzumab, and
trastuzumab (these are the drugs listed in the Medicare Claims Processing Manual for Chemotherapy). If your physician's documentation make this higher level of care clear at the time of the injection you can try 96401, but do not be surprised if you get a denial and from other clients I have, appeal generally fails when 96401 is billed without detailed documentation outlining the complex work involved. I would bill J0897 with a $0.00 or $0.01 charge as many payers will deny the injection procedure without a J code, but will not process the J code with such a low charge.
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