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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

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