YOUR GUIDE TO EVENITY BILLING AND CODING INFORMATION - Amgen Assist ...
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YOUR GUIDE TO EVENITY™
BILLING AND CODING
INFORMATION
FOR PHYSICIAN OFFICES USING THE CMS 1500
FOR HOSPITALS/INSTITUTIONS USING THE CMS 1450
The information provided in this guide is of a general nature and for informational purposes only. Coding and coverage policies change
periodically and often without warning. The responsibility to determine coverage and reimbursement parameters, and appropriate
coding for a particular patient and/or procedure, is always the responsibility of the provider or physician. The information provided in
this guide should in no way be considered a guarantee of coverage or reimbursement for any product or service.
Call Amgen Assist® for assistance with specific payer requirements:
1-866-AMG-ASST (1-866-264-2778) Monday through Friday, 9:00 am to 8:00 pm ET.
INDICATION
EVENITY™ is indicated for the treatment of osteoporosis in postmenopausal women at high risk for fracture, defined as a history of
osteoporotic fracture, or multiple risk factors for fracture; or patients who have failed or are intolerant to other available osteoporosis therapy.
The anabolic effect of EVENITY™ wanes after 12 monthly doses of therapy. Therefore, the duration of EVENITY™ use should be limited to
12 monthly doses. If osteoporosis therapy remains warranted, continued therapy with an antiresorptive agent should be considered.
IMPORTANT SAFETY INFORMATION
POTENTIAL RISK OF MYOCARDIAL INFARCTION, STROKE, AND CARDIOVASCULAR DEATH
EVENITY™ may increase the risk of myocardial infarction, stroke and cardiovascular death.
EVENITY™ should not be initiated in patients who have had a myocardial infarction or
stroke within the preceding year. Consider whether the benefits outweigh the risks in
patients with other cardiovascular risk factors. Monitor for signs and symptoms of
myocardial infarction and stroke and instruct patients to seek prompt medical attention
if symptoms occur. If a patient experiences a myocardial infarction or stroke during
therapy, EVENITY™ should be discontinued.
Please see additional Important Safety Information on the back cover.Physician Office Billing Information Completing the CMS 1500 for Physician Offices
PHYSICIAN OFFICES (CMS 1500)
EVENITY™ (romosozumab-aqqg) Coding Information
Additional Claim Information
in Box 19: EVENITY™ (romosozumab-aqqg), 210 mg, subcutaneous injection, NDC 55513088002
(Electronic Form: Loop 2300,
or 2400, NTE, 02)1
As with most newly FDA-approved products, a temporary J-Code is required until a
permanent code for EVENITY™ is established.
J3590 (Unclassified biologics) or J3490 (Unclassified drugs).2,3 X XXX-XX-XXXX
Coding Information in Box 24D: Billing requirements for unclassified or miscellaneous codes may vary by payer;
Doe, Jane J 06 01 1930 X Doe, Jane J
(Electronic Form: Loop 2400, SV1, 01-2)1 however, payers typically require providers to list product name, route of administration,
total dosage, and NDC number(s) for units used during the billing period in Box 19 (or 1123 Main Street
corresponding field for electronic claims).*
NDC number 55513-0880-02 can be used for billing purposes.4 Hometown MA
Number of Units in Box 24G: Indicate 1 unit for one kit. Each EVENITY™ kit contains one dose, which is 2 injections for a 01234 XXX XXX-XXXX
(Electronic Form: Loop 2400, SV1, total dose of 210 mg.4
04 [03=UN])1 The NDC number covers both injections. 11111
X 06 01 1930 X
Administration and Professional Service Coding Information* X ABC Employer
The following code may be available to report administration of EVENITY™. Other codes may
be appropriate on a payer-specific basis. It is the provider’s responsibility to ensure that X
codes used are consistent with payer policy and reflect service performed under such codes:
• 96372 (therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous (BOX 19) ADDITIONAL X
Coding Information in Box 24D: CLAIM INFORMATION:
or intramuscular)5
(Electronic Form: Loop 2400, SV1, 01-2)1 Indicate EVENITY™
• Relevant evaluation and management (E&M) code. Note when an E&M service is billed in
addition to other professional services, the following modifier may be required to distinguish it as (romosozumab-aqqg), 210 mg,
subcutaneous injection, NDC
a separate service: -.25 (significant, separately identifiable evaluation and management service by
55513088002
the same physician on the same day of the procedure or other service)
(BOX 24G) DAYS
Each EVENITY™ kit contains one dose, which is 2 injections for a total dose of 210 mg.4 OR UNITS:
Considerations: Applicable codes cover both injections.
EVENITY™ (romosozumab-aqqg), 210 mg, subcutaneous injection, NDC 55513088002 Indicate 1 unit for one kit.
Each EVENITY™ kit contains
Diagnosis Code Information* M80.0
one dose, which is 2 injections.
The following primary ICD-10-CM diagnosis code may be appropriate to describe patients
with current osteoporotic fracture treated with EVENITY™:
• M80.0 (Age-related osteoporosis with current pathological fracture)6
ICD-10-CM Code in Box 21: (BOX 21) DIAGNOSIS
Please see page 6 for additional examples for patients with current osteoporotic fracture. OR01
NATURE
(Electronic Form: Loop 2300, HI, 01-2) 1 23 14OF01 23 14 11 J3590 XXX XX 1
The following primary diagnosis code may be appropriate to describe patients ILLNESS OR INJURY:
without current osteoporotic fracture treated with EVENITY™: Indicate01 23 14 ICD01
appropriate 23 14
diagnosis 11 96372 XXX XX 1
• M81.0 (Age-related osteoporosis without current pathological fracture)6,† code as reflected in the patient’s
medical record. ICD-10 code (BOX 24D) PROCEDURES,
*The sample codes are informational and not intended to be directive or a guarantee of reimbursement and include potential codes that would include example: M80.0 (Age-related SERVICES, OR SUPPLIES:
FDA-approved indications for EVENITY™. Other codes may be more appropriate given internal system guidelines, payer requirements, practice patterns, osteoporosis with current Indicate appropriate HCPCS and CPT codes.
and the services rendered. pathological fracture). Example: J3590 (Unclassified biologics) or
†According to the ICD-10-CM Official Guidelines for Coding and Reporting, M81 code is for use with patients with osteoporosis who do not currently have J3490 (Unclassified drugs). 96372 (Therapeutic,
a pathologic fracture due to the osteoporosis, even if they have had a fracture in the past. For patients with a history of osteoporosis fractures, status prophylactic, or diagnostic injection [specify
code Z87.310 (personal history of [healed] osteoporosis fracture) should follow the code from the M81 category.7 substance or drug]; subcutaneous or
11-1111111 X intramuscular). X XXX XX
Please note: Each EVENITY™ kit contains one
dose, which is 2 injections. Applicable codes John Smith MD
Call Amgen Assist® for support with billing and coding questions: 1-866-AMG-ASST (1-866-264-2778) cover both injections. 2 Doctors Blvd
Monday through Friday, 9:00 am to 8:00 pm ET. Hometown, MA 01234
08-22-17 XXXXXXXXX XXXXXXXXX
2 3Hospital/Institutional Billing Information Completing the CMS 1450 Form for Hospitals
EVENITY™ (romosozumab-aqqg) Coding Information __ __ __
Revenue Code in Box 42: Medicare: 0636, drugs requiring detailed coding.9
Anytown Hospital
1 2 3a PAT. 4 TYPE
CNTL # OF BILL
(Electronic Form: Loop 2400, SV201)8 Other Payers: 0250, general pharmacy; OR 0636, if required by a given payer.9,10 100 Main Street
b. MED.
REC. #
Anytown, Anystate 01010
6 STATEMENT COVERS PERIOD 7
5 FED. TAX NO.
As with most newly FDA-approved products, temporary J-Codes and C-Codes are required FROM THROUGH
until a permanent code for EVENITY™ is established. 8 (BOX Smith,
42) REVENUE CODES:James
PATIENT NAME a 9 PATIENT ADDRESS a
123 Main Street, Anytown, Anystate 12345
HCPCS Code (J-Code): J3590 (Unclassified biologics) or J3490 (Unclassified drugs)2,3 Product
b b c d e
ADMISSION CONDITION CODES 29 ACDT 30
Billing requirements for unclassified or miscellaneous codes may vary by payer; however, payers typically Medicare: Use revenue
10 BIRTHDATE 11 SEX
code
12 0636, drugs
DATE 13 HR 14requiring
TYPE 15 SRC 16 DHR 17 STAT 18 19 20 21 22 23 24 25 26 27 28 STATE
Coding Information in Box 44: require providers to list product name, route of administration, total dosage, and NDC number(s) detailed coding. (BOX 46)
(Electronic Form: Loop 2400, for units used during the billing period in Box 80 (or corresponding field for electronic claims).*
31
Other
OCCURRENCE
payers:DATE
CODE
32
Use revenue
CODE
OCCURRENCE
codeDATE
33
0250, general
CODE
OCCURRENCE
DATE
34
CODE
OCCURRENCE
DATE
35
CODE SERVICE
FROM UNITS:
OCCURRENCE SPAN
THROUGH
36
CODE
(BOX
FROM
OCCURRENCE SPAN
47) THROUGH
37
SV202-2 [SV202-1=HC/HP])8 a
pharmacy (or 0636, if required by a given payer). Indicate 1 unit for one kit. TOTAL CHARGES:
a
C-Code: C9399 (Unclassified drugs or biologicals)11.
Each EVENITY™ kit
b b
Related
38 Administration Procedure 39 VALUE CODES 40 Report appropriate41charges
VALUE CODES VALUE CODES
C-Codes are unique temporary pricing codes for hospital outpatient department services contains one dose,
CODE which
AMOUNT CODE AMOUNT CODE AMOUNT
Use most appropriate revenue code or cost center a for product used and related
and procedures. is 2 injections. procedures.
where services were performed (eg, 0510, clinic). b
NDC number 55513-0880-02 can be used for billing purposes.4 c
Service Units in Box 46: Indicate 1 unit for one kit. Each EVENITY™ kit contains one dose, which is 2 injections for a total d
dose of 210 mg.4 The NDC number covers both injections.
42 REV. CD. 43 DESCRIPTION 44 HCPCS / RATE / HIPPS CODE 45 SERV. DATE 46 SERV. UNITS 47 TOTAL CHARGES 48 NON-COVERED CHARGES 49
(Electronic Form: Loop 2400, SV205)8 1
0636 EVENITY 210 mg C9399 MMDDYY 1 XXXXX 1
0510 Clinic 96372 MMDDYY 1 XXXXX
Administration Coding Information*
2 2
3 3
HOSPITALS/INSTITUTIONS (CMS 1450)
4 4
Revenue Code in Box 42: Appropriate revenue code for the cost center in which the service is performed.
5 (BOX 43) DESCRIPTION: (BOX 44) PRODUCT AND 5
(Electronic Form: Loop 2400, SV201) 8 6
Indicate the drug name and unit of PROCEDURE CODES: 6
7
measure: EVENITY™ 210 mg. Product 7
Description in Box 43: Indicate drug name and unit of measure, for example EVENITY™ 210 mg. 8 8
Use C9399 (Unclassified drugs or biologics)
(Not required by Medicare)8 9 9
Related Administration Procedure
• 96372, therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous
10 10
11 Use CPT code representing procedure performed, 11
or intramuscular5 such as 96372, therapeutic, prophylactic, or
Coding Information in Box 44: 12 12
• Relevant evaluation and management (E&M) code. Note when an E&M service is billed in addition 13 diagnostic injection [specify substance or drug]; 13
(Electronic Form: Loop 2400,
to other professional services, the following modifier may be required to distinguish it as a separate 14 subcutaneous or intramuscular. Please note, 14
SV202-2 [SV202-1=HC/HP])8 each EVENITY™ kit contains one dose, which is 2
service: -.25 (significant, separately identifiable evaluation and management service by the same 15 15
physician on the same day of the procedure or other service) 16
injections. Applicable codes cover both injections. 16
Each EVENITY™ kit contains one dose, which is 2 injections for a total dose of 210 mg. Applicable
4
17
Healthcare providers should consult the payer or 17
Considerations: codes cover both injections.
18
19
Medicare contractor to determine which code is
18
19
most appropriate for administration of EVENITY™.
20 20
Diagnosis/Condition Code Information* 21
22
21
22
Revenue Code: N/A 23
PAGE OF CREATION DATE
52 REL. 53 ASG.
TOTALS 23
50 PAYER NAME 51 HEALTH PLAN ID 54 PRIOR PAYMENTS 55 EST. AMOUNT DUE 56 NPI
Appropriate ICD-10-CM code(s) for patient condition.
INFO BEN.
A 57 A
Sequencing of codes may vary based on patient’s condition and payer’s policy. B OTHER B
C PRV ID C
The following primary ICD-10-CM diagnosis code may be appropriate to describe patients
58 INSURED’S NAME 59 P. REL 60 INSURED’S UNIQUE ID 61 GROUP NAME 62 INSURANCE GROUP NO.
ICD-10-CM Code in Box 66: with current osteoporotic fracture treated with EVENITY™: A
(BOX 66) DIAGNOSIS CODES: A
(Electronic Form: Loop 2300, • M80.0 (Age-related osteoporosis with current pathological fracture)6 Indicate appropriate ICD diagnosis code as
B B
reflected in the patient’s medical record.
HI01-2 [HI01-1=BK])8 Please see page 6 for additional examples for patients with current osteoporotic fracture. C C
ICD-10 code example:
63 TREATMENT AUTHORIZATIONM80.0
CODES (Age-related 64 DOCUMENT CONTROL NUMBER 65 EMPLOYER NAME
The following primary ICD-10-CM diagnosis code may be appropriate to describe patients osteoporosis with current pathological fracture).
A A
without current osteoporotic fracture treated with EVENITY™: B B
• M81.0 (Age-related osteoporosis without current pathological fracture)6,† C C
66
DX 67
M80.0 A B C D E F G H 68
*The sample codes are informational and not intended to be directive or a guarantee of reimbursement and include potential codes that would I J K L M N O P Q
include FDA-approved indications for EVENITY™. Other codes may be more appropriate given internal system guidelines, payer requirements, 69 ADMIT
DX
70 PATIENT
REASON DX a
(BOX 80) REMARKS:
b c 71 PPS
CODE
72
ECI a b c 73
practice patterns, and the services rendered. 74 PRINCIPAL PROCEDURE
CODE DATE
a. OTHER PROCEDURE
CODE DATE
b. OTHER PROCEDURE
CODE DATE
75
76 ATTENDING NPI QUAL
†According to the ICD-10-CM Official Guidelines for Coding and Reporting, M81 code is for use with patients with osteoporosis who do not currently Payers typically require providers to list product name, route of administration, LAST FIRST
have a pathologic fracture due to the osteoporosis, even if they have had a fracture in the past. For patients with a history of osteoporosis fractures, c.
total dosage, andd.NDCCODE
OTHER PROCEDURE
CODE DATE number(s) forDATE
OTHER PROCEDURE
the units
e.
used
CODEduring theDATE
billing period.
OTHER PROCEDURE
77 OPERATING NPI QUAL
status code Z87.310 (personal history of [healed] osteoporosis fracture) should follow the code from the M81 category.7 LAST FIRST
81CC
80 REMARKS 78 OTHER NPI QUAL
a
EVENITY (romosozumab-aqqg), b LAST FIRST
subcutaneous, 210 mg
Call Amgen Assist® for support with billing and coding questions: 1-866-AMG-ASST (1-866-264-2778) NDC: 55513088002
c
d
79 OTHER
LAST
NPI QUAL
FIRST
Monday through Friday, 9:00 am to 8:00 pm ET. UB-04 CMS-1450 APPROVED OMB NO. 0938-0997
NUBC
™ National Uniform
Billing Committee
THE CERTIFICATIONS ON THE REVERSE APPLY TO THIS BILL AND ARE MADE A PART HEREOF.
4 5PhysicianExamples of ICD-10-CM
Office Billing Codes Relevant for Patients With Current
Information
Osteoporotic Fracture Treated With EVENITY™
6
Hypothetical Scenarios Illustrating Specificity of M80.0_ _ _ ICD-10-CM Codes
EVENITY™ (romosozumab-aqqg) Coding
Age-related osteoporosis with Information
current pathological fracture CLINICAL DIAGNOSIS DETAILS POTENTIAL ICD-10-CM CODE6
M80.0___
Additional (laterality) (anatomic site) (encounter type)*
Claim Information
in Box 19: EVENITY™ (romosozumab-aqqg), 210 mg, subcutaneous injection, NDC 55513088002
(Electronic Form: Loop 2300, Encounter Type †
Age-related
or 2400, NTE, 02)1 osteoporosis
Subsequent Subsequent Subsequent Subsequent
As with mostfor
encounter newly FDA-approved
encounter for products, a temporary
encounter for J-Code is required
encounter for until a with current
Anatomic Site pathological
Initial encounter permanent
fracture with fracture with
code for EVENITY™ fracture with
is established. fracture with
and Laterality for fracture routine healing eddelayed healing nonunion ed drugs).
malunion Sequela fracture
J3590 (Unclassifi biologics) or J3490 (Unclassifi 2,3
• Postmenopausal osteoporosis
Coding Information
UNSPECIFIED SITE in Box 24D:
M80.00XA M80.00XD
Billing M80.00XG
requirements for M80.00XK
unclassified or miscellaneous codesM80.00XP M80.00XS
may vary by payer; • Vertebral fractures
SHOULDER
(Electronic Form: Loop 2400, SV1, 01-2)1 however, payers typically require providers to list product name, route of administration, • Encounter for evaluating and continuing
Right
Left
M80.011A
M80.012A
totalM80.011D
dosage, and NDC number(s)
corresponding
M80.011G for unitsM80.011K
M80.012D field forM80.012G
used during the billing
electronic claims).*M80.012K
period in Box M80.011S
M80.011P
M80.012P
19 (or
M80.012S
treatment for the fractures M80.08XA Initial encounter
for fracture
Unspecified M80.019A NDCM80.019D M80.019Gcan be used
number 55513-0880-02 M80.019K M80.019P
for billing purposes. 4 M80.019S
HUMERUS
Number Fracture of
Right of Units in Box 24G:
M80.021A
Indicate 1 unit for one M80.021G
M80.021D
kit. Each EVENITY™M80.021K
kit contains one dose, which is 2 injections
M80.021P
for a
M80.021S
(Electronic total dose of 210 mg.4 vertebrae
Left Form: Loop 2400, SV1,
M80.022A M80.022D M80.022G M80.022K M80.022P M80.022S
04 [03=UN]) 1 The NDC number covers both injections.
Unspecified M80.029A M80.029D M80.029G M80.029K M80.029P M80.029S
FOREARM
Administration and Professional
Right M80.031D Service
M80.031A Coding Information*
M80.031G M80.031K M80.031P M80.031S
CLINICAL DIAGNOSIS DETAILS POTENTIAL ICD-10-CM CODE
Left M80.032A M80.032D M80.032G M80.032K M80.032P M80.032S
The following code may be available to report administration of EVENITY™. Other codes may
Unspecified M80.039A M80.039D on a payer-specifi
be appropriate M80.039G c basis. ItM80.039K M80.039P to ensure
is the provider’s responsibility M80.039S
that
HAND codes used are consistent with payer policy and reflect service performed under such codes:
Right M80.041A M80.041D M80.041G M80.041K M80.041P M80.041S Age-related
• 96372 (therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous
CodingLeftInformation in Box 24D:
M80.042A M80.042D M80.042G M80.042K M80.042P M80.042S osteoporosis
or intramuscular) 5
with current
(Electronic Form:
Unspecified Loop 2400, SV1, 01-2)1
M80.049A M80.049D M80.049G M80.049K M80.049P M80.049S
• Relevant evaluation and management (E&M) code. Note when an E&M service is billed in pathological
FEMUR addition to other professional services, the following modifier may be required to distinguish it as
Right M80.051A M80.051D
• Postmenopausal osteoporosis fracture Left
a separate service: -.25M80.051G M80.051K
(significant, separately M80.051P
identifiable evaluation M80.051S
and management service by
• Fracture of left wrist
Left M80.052A theM80.052D M80.052G
same physician on the M80.052Kor other service)
same day of the procedure M80.052P M80.052S
• Follow-up encounter for routine fracture Subsequent
Unspecified M80.059A M80.059D M80.059G M80.059K M80.059P M80.059S
Considerations:
LOWER LEG
Right M80.061A
Each EVENITY™ kit contains one dose, which is 2 injections for a total dose of 210 mg.
Applicable codes cover both injections.
M80.061D M80.061G M80.061K M80.061P
4
M80.061S
management (after active treatment
has been completed) M80.032D encounter for
fracture with
routine healing
Left M80.062A M80.062D M80.062G M80.062K M80.062P M80.062S
Diagnosis Code Information*
Unspecified M80.069A M80.069D M80.069G M80.069K M80.069P M80.069S
Fracture of
ANKLE AND FOOT
The following primary ICD-10-CM diagnosis code may be appropriate to describe patients forearm
Right M80.071A
withM80.071D M80.071G
current osteoporotic fracture treatedM80.071K
with EVENITY™: M80.071P M80.071S
Left M80.072A M80.072D M80.072G M80.072K M80.072P M80.072S
• M80.0 (Age-related osteoporosis with current pathological fracture)6
Unspecified
ICD-10-CM M80.079A
Code in Box 21: M80.079D M80.079G M80.079K M80.079P M80.079S
VERTEBRA(E) M80.08XA Please see page 6 for additional
M80.08XD M80.08XG examples for patients with current
M80.08XK osteoporotic
M80.08XP fracture.
M80.08XS
(Electronic Form: Loop 2300, HI, 01-2)1
The following primary diagnosis code may be appropriate to describe patients
See the next page for hypothetical scenarios illustrating
without currentspecifi city of these
osteoporotic M80.0_
fracture _ _ ICD-10-CM
treated codes. The diagnosis code
with EVENITY™: References: 1. Palmetto GBA. ASC 837 v5010 to CMS-1500 Crosswalk. http://www.palmettogba.com/Palmetto/Providers.Nsf/files/CMS1500_837v5010_
examples above and the hypothetical scenarios on back of the insert are informational and should not be a substitute for an
• M81.0 (Age-related osteoporosis without current pathological fracture)6,† Crosswalk.pdf/$File/CMS1500_837v5010_Crosswalk.pdf. Accessed February 14, 2019. 2. HCPCS.codes. HCPCS J-Codes. http://hcpcs.codes/j-codes/J3590/.
independent clinical decision. They are not intended to be directive or a guarantee of reimbursement. The responsibility to determine Accessed February 14, 2019. 3. HCPCS.codes. HCPCS J-Codes. http://hcpcs.codes/j-codes/J3490/. Accessed February 14, 2019. 4. EVENITY™ (romosozumab-aqqg)
ICD-10-CM CODE EX AMPLES
coverage
*The sample andare
codes reimbursement parameters,
informational and and
not intended appropriate
to be directive orcoding for a of
a guarantee particular patient,and
reimbursement is always the responsibility
include potential codes thatof the include
would provider prescribing information, Amgen. 5. American Medical Association. 2017 Professional Edition, Current Procedural Terminology (CPT) copyright 2016 American
or physician.
FDA-approved Please contact
indications your payer
for EVENITY™. with any
Other codes mayquestions.
be more appropriate given internal system guidelines, payer requirements, practice patterns, Medical Association. All rights reserved. 6. Centers for Disease Control and Prevention. 2019 ICD-10-CM tabular list of diseases and injuries. In: International
and the services rendered. Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM). FY 2019. Full PDF. ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/
ICD10CM/2019/. Accessed February 14, 2019. 7. CMS. ICD-10-CM official guidelines for coding and reporting, FY 2019. https://www.cdc.gov/nchs/icd/
*According
†According to thetoICD-10-CM
the ICD-10-CM OffiGuidelines
Official cial Guidelines for Coding
for Coding and Reporting,
and Reporting, M80.0
M81 code codes
is for useare forpatients
with patientswith
whoosteoporosis
have a current
whopathologic fracturehave
do not currently at data/10cmguidelines-FY2019-final.pdf. Accessed February 14, 2019. 8. Palmetto GBA. ASC 837I version 5010A2 Institutional Health Care Claim to the CMS-
the timefracture
a pathologic of an encounter.
due to theTh e codes under
osteoporosis, M80if identify
even they havethehad
sitea of the fracture.
fracture A code
in the past. Forfrom category
patients with M80, not of
a history a traumatic fracture
osteoporosis code, should
fractures, status be 1450 Claim Form Crosswalk. http://www.palmettogba.com/Palmetto/Providers.Nsf/files/EDI_837I_
codeused for (personal
Z87.310 any patienthistory
with known osteoporosis
of [healed] who suff
osteoporosis ers a fracture,
fracture) even the
should follow if the patient
code fromhadtheaM81
minor fall or trauma,
category. 7
if that fall or trauma would not v5010A2_crosswalk.pdf/$File/EDI_837I_v5010A2_crosswalk.pdf. Accessed February 14, 2019. 9. Value
usually break a normal, healthy bone.7 Healthcare Services. Understanding hospital revenue codes. http://valuehealthcareservices.com/education/
†According to the ICD-10-CM Official Guidelines for Coding and Reporting, seventh character A is for use as long as the patient is receiving understanding-hospital-revenue-codes/. Accessed February 14, 2019. 10. Centers for Medicare & Medicaid
active
Call treatment
Amgen for the ®fracture.
Assist Assignment
for support of the
with seventh
billing andcharacter
coding is based on whether
questions: the patient is undergoing(1-866-264-2778)
1-866-AMG-ASST active treatment and not Services. Publication 100-04: Medicare Claims Processing Manual. Chapter 17: drugs and biologicals. Section
whether the provider is seeing the patient for the first time. Seventh character D is to be used for encounters after the patient has completed 80.9: required modifiers for ESAs administered to non-ESRD patients. http://www.cms.gov/Regulations-
Monday through
active treatment. Friday,
The other 9:00
seventh am to listed
characters, 8:00under
pm each
ET. subcategory in the Tabular List, are to be used for subsequent encounters for and-Guidance/Guidance/Manuals/downloads/clm104c17.pdf. Accessed February 14, 2019. 11. HCPCS.codes.
treatment of problems associated with healing, such as malunions, nonunions, and sequelae.7 HCPCS C-Codes. http://hcpcs.codes/j-codes/C9399/. Accessed February 14, 2019.
6
2 7
USA-785-80323 04-19 All rights reserved. © 2019 Amgen Inc.
Please see additional Important Safety Information on the back cover. www.amgen.com after rendering serviceConsiderations
Important Safety Information
for Complete POTENTIAL RISK OF MYOCARDIAL INFARCTION, STROKE, AND CARDIOVASCULAR DEATH
EVENITY™ may increase the risk of myocardial infarction, stroke and cardiovascular death. EVENITY™ should not be initiated in patients who
Claim Submission have had a myocardial infarction or stroke within the preceding year. Consider whether the benefits outweigh the risks in patients with other
cardiovascular risk factors. Monitor for signs and symptoms of myocardial infarction and stroke and instruct patients to seek prompt medical
attention if symptoms occur. If a patient experiences a myocardial infarction or stroke during therapy, EVENITY™ should be discontinued.
In a randomized controlled trial in postmenopausal women, there was a higher rate of major adverse cardiac events (MACE), a composite
endpoint of cardiovascular death, nonfatal myocardial infarction and nonfatal stroke, in patients treated with EVENITY™ compared to those
CORRECT AND COMPLETE PATIENT treated with alendronate.
INFORMATION:
Contraindications: EVENITY™ is contraindicated in patients with hypocalcemia. Pre-existing hypocalcemia must be corrected prior to initiating
Patient name therapy with EVENITY™. EVENITY™ is contraindicated in patients with a history of systemic hypersensitivity to romosozumab or to any
– ID number component of the product formulation. Reactions have included angioedema, erythema multiforme, and urticaria.
– Health insurer name and/or Hypersensitivity: Hypersensitivity reactions, including angioedema, erythema multiforme, dermatitis, rash, and urticaria have occurred in
group number EVENITY™-treated patients. If an anaphylactic or other clinically significant allergic reaction occurs, initiate appropriate therapy and
discontinue further use of EVENITY™.
Provider name
Hypocalcemia: Hypocalcemia has occurred in patients receiving EVENITY™. Correct hypocalcemia prior to initiating EVENITY™. Monitor patients
– National provider ID number
for signs and symptoms of hypocalcemia, particularly in patients with severe renal impairment or receiving dialysis. Adequately supplement
– Contact information patients with calcium and vitamin D while on EVENITY™.
Osteonecrosis of the Jaw (ONJ): ONJ, which can occur spontaneously, is generally associated with tooth extraction and/or local infection with
COLLECT EVENITY™ INFORMATION: delayed healing, and has been reported in patients receiving EVENITY™. A routine oral exam should be performed by the prescriber prior to
Correct HCPCS code and units initiation of EVENITY™. Concomitant administration of drugs associated with ONJ (chemotherapy, bisphosphonates, denosumab, angiogenesis
inhibitors, and corticosteroids) may increase the risk of developing ONJ. Other risk factors for ONJ include cancer, radiotherapy, poor oral
Diagnosis code to the highest level hygiene, pre-existing dental disease or infection, anemia, and coagulopathy.
of specificity
For patients requiring invasive dental procedures, clinical judgment should guide the management plan of each patient. Patients who are
– Primary diagnosis code
suspected of having or who develop ONJ should receive care by a dentist or an oral surgeon. In these patients, dental surgery to treat ONJ may
PA if available exacerbate the condition. Discontinuation of EVENITY™ should be considered based on benefit-risk assessment.
Atypical Femoral Fractures: Atypical low-energy or low trauma fractures of the femoral shaft have been reported in patients receiving
INCLUDE REQUIRED SUPPLEMENTAL EVENITY™. Causality has not been established as these fractures also occur in osteoporotic patients who have not been treated.
DOCUMENTATION : Th
During EVENITY™ treatment, patients should be advised to report new or unusual thigh, hip, or groin pain. Any patient who presents with thigh pe
Original diagnostic T-score or groin pain should be evaluated to rule out an incomplete femur fracture. Interruption of EVENITY™ therapy should be considered based on co
Previous therapies benefit-risk assessment. thi
– Reason for discontinuations Adverse Reactions: The most common adverse reactions (≥ 5%) reported with EVENITY™ were arthralgia and headache.
Calcium levels EVENITY™ is a humanized monoclonal antibody. As with all therapeutic proteins, there is potential for immunogenicity.
Prior fracture history Please see accompanying EVENITY™ full Prescribing Information, including Medication Guide.
– Location of fracture
(please provide ICD-10 number[s])
IND
Cardiovascular risk assessment EV
– List any documented myocardial os
Th
ICD-10-CM CODE EX AMPLES
infarction or stroke events within
the last 12 months
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