PROLIA

A drug called Prolia® (denosumab) is used to treat osteoporosis in particular patient groups. Accurate reimbursement and compliance depend on proper billing and coding. The following are important Prolia® code details:
Code for HCPCS:
J0897: Denosumab injection, 1 mg Common ICD-10-CM Codes for diagnosis:
M81.0: Osteoporosis associated with aging without a pathological fracture at present
M80.0XXA: Current pathological fracture and age-related osteoporosis
M80.8XXA: Additional osteoporosis with a pathological fracture at the moment

Administration Codes: 96401: Intramuscular or subcutaneous delivery of chemotherapy; non-hormonal anti-neoplastic
96372: Intramuscular or subcutaneous injection for therapeutic, preventative, or diagnostic purposes
The decision between administration codes 96401 and 96372 may change depending on the particular clinical situation and payer criteria. To find the right code, it's best to refer to payer policies.
Consult the Prolia® Coding and Billing Information Guide for thorough details, including specific coding scenarios and billing advice. This manual offers comprehensive advice to help medical professionals use proper coding procedures.
To enable appropriate reimbursement, always make sure that documentation complies with payer-specific rules and demonstrates Prolia®'s medical necessity.