ICD-9 Codes that Support Medical Necessity for Boniva, Zometa, Reclast, Prolia and Xgeva

HCPCS Code J1740 (Boniva)   

733.01 Senile osteoporosis
733.09* Other osteoporosis
E932.0* Adrenal cortical steroids causing adverse effects in therapeutic use

*When reporting ICD-9-CM code 733.09, the ICD-9-CM coding manual requires a dual diagnosis. In this regard, when reporting ICD-9-CM code 733.09 (other, osteoporosis), ICD-9-CM code E932.0 (adrenal cortical steroids) must also be reported.

HCPCS Code J3487 (Zometa)

198.5 Secondary malignant neoplasm of bone and bone marrow
203.00-203.02 Multiple myeloma
275.42 Hypercalcemia
733.90 Disorder of bone and cartilage, unspecified

HCPCS Code J3488 (Reclast)

731.0 Osteitis deformans without mention of bone tumor
733.01 Senile osteoporosis
733.09* Other osteoporosis
E932.0* Adrenal cortical steroids causing adverse effects in therapeutic use

*When reporting ICD-9-CM code 733.09, the ICD-9-CM coding manual requires a dual diagnosis. In this regard, when reporting ICD-9-CM code 733.09 (other, osteoporosis), ICD-9-CM code E932.0 (adrenal cortical steroids) must also be reported.

HCPCS Code J0897 (Prolia)

733.00-733.03 Osteoporosis
733.90 Disorder of bone and cartilage, unspecified
733.09 Other osteoporosis

HCPCS Code J0897 (Xgeva)

198.5 Secondary malignant neoplasm of bone and bone marrow

See also

Coverage and Limitations for Boniva, Zometa, Reclast, Prolia and Xgeva

Documentations Requirements for Boniva, Zometa, Reclast, Prolia and Xgeva