Compliance Question of the Week – Pharmacy

We get a local coverage determination (LCD) edit for J1815 (injection, insulin, per 5 units) for many accounts. Many times, coders have coded DM with complications (without coma), but we couldn’t result the LCD edit for J1815. Do you have any suggestions about LCD edits for J1815 issue with diagnosis issue?

What code should be assigned for Prolia?

I believe that part of the answer in last week’s posting is incorrect. You stated that code Q5102 (which describes both currently available versions of infliximab biosimilars) will be discontinued and replaced with codes 5102 and 5014. Although it’s true Q5102 will be discontinued March 31, 2018, I don’t think the replacement codes are correct. Can you provide the right codes?

Are modifiers required when billing biosimilar products?

Are there any new drugs with pass-through status for the next quarter?

When using the JW modifier, should the dollar amount be included on the wastage line or should the line reflect units only?

Does Medicare pay for an office visit so that the patient could receive an injection?

When a patient comes in for a cancer chemo injection, can we be paid for the visit too?

Is Q5102 still the code to assign for an injection of the biosimilar infliximab?

Are there any modifiers to report 340B-acquired drugs to Medicare?

On which types of pharmacy claims must hematocrit or hemoglobin readings be reported?

When should pharmacies use the KX modifier?