Zoledronic acid J code

Zoledronic Acid J Code Description, Reimbursement, Modifiers & Guidelines

Zoledronic acid J code (HCPCS J3489) is applied for service when Zoledronic acid (1 mg) injects by the physician or other healthcare provider. Zoledronic acid administers to the patient to treat abnormal blood calcium levels caused by cancer and bone metastases from solid tumors.

Zoledronic Acid J Code Description

Zoledronic acid aids to decreased the amount of calcium in the bloodstream and lowers bone breakdown.

Zoledronic acid acts as an inhibitor to stimulate bones’ normal and abnormal reabsorption.

This mechanism plays a vital role in reducing pain and hypercalcemia and preventing bone fractures in many diseases. 

 The following are the reasons why zoledronic acid administers to the patient:

To treat hypercalcemia of malignancy.

The treatment and prevention of postmenopausal osteoporosis and glucosteroid-induced osteoporosis.

To increase bone mass in men with osteoporosis.

Treatment of Paget’s disease in men and women.

To treat multiple myeloma and bone metastases from solid tumor cancers.

J3489
HCPCS Code J3489

The cancer cells influence the release of calcium stored in the bones into the bloodstream.

The accumulation of calcium levels in the bloodstream occurs due to malignancy.

Zoledronic acid injects via infusion, which is typically not less than 15 minutes. 

Zoledronic acid J code J3489 drug acts as an inhibitor to stimulate the normal and abnormal reabsorption of bones.

This mechanism plays a vital role in lowering pain, hypercalcemia, and risk of fractures.

It also contributes to the remodeling of bone and the impact of the disease. 

Zoledronic acid J code J3489 is applied for service when Zoledronic acid (1 mg) injects by the physician or other healthcare provider. 

Zoledronic Acid J Code Reimbursement  

A maximum of five units of HCPCS J3489 is allowed to bill on the same day. In contrast, a maximum of three times are allowed when documentation supports the medical necessity of Zoledronic acid J code J3489

The HCPCS J3489 cost and RUVS are as follows when performed in the facility, it will be $8.25 and 0, respectively. In contrast, non-facility will be $8.25 and 0, respectively.

Zoledronic Acid J Code Modifiers 

The following is the list of modifiers that are applicable with Zoledronic acid J code J3489

  • 52, 58, 59, 76, 77, 78, 79, 99, AI, CC, CR, ET, EY, GA, GC, GJ, GK, GR, GU, GY, GZ, JA, JW, KD, KX, LT, Q5, Q6, QJ, RT, SG, XE, XP, XS, XU.

If a physician believes that Medicare will deny such service, it is appropriate to report with a GZ modifier.

In comparison, If the service already performs, modifier GA applies with HCPCS J3489.

The beneficiary must sign an Advance Beneficiary Notification (ABN), and the GA modifier must apply to that service. 

Modifier 52 is applicable with Zoledronic acid J code J3489 when the zoledronic acid dose reduces by the physician due to unavoidable circumstances.

Modifier 76 will be attached to HCPCS code J3489 if the same physician repeats service on the same day.

In contrast, modifier 77 is appropriate when a procedure repeats on the same date service by a different physician. 

Modifier 78 will be appended with Zoledronic acid J code J3489 if the procedure repeats for an identical condition in the global period. 

In contrast, modifier 79 is applicable when the service reports for an unrelated condition. 

Modifier 59 is applicable with Zoledronic acid J code J3489 if any other procedure performs in combination with these services.

They do not typically render together on the same date of service.

Moreover, modifier 59 will be appropriate, or service performs on the distinct region on the same day. 

Modifier 58 will be reported with HCPCS code J3489 if the physician plans to give Zoledronic acid in the post-operative period.

Zoledronic Acid J Code Billing Guidelines 

Documentation must support the medical necessity of service and be medically appropriate.

The common ICD 10 codes billed with HCPCS J3489 are as follows:

  • E83.52, M80.0AXA, M81.0, M81.8, M85.9, M88.0, M881.1, M88.811, M88.812, M88.819, M88.821, M88.822, M88.829, M88.931, M88.832, M88.839, M88.841, M88.842, M88.849, M88.851, M88.852, M88.859, M88.861, M88.862, M88.869, M88.871, M88.872, M88.879, M88.88, M88.89, and M88.9.

Zoledronic acid J code J3489 administers via infusion, and it typically requires 15 minutes to infuse. It does not appropriate to report with an IV code.

A maximum of 5 mg (J3489) allows to bill in one day. If more than five units of Zoledronic acid J code J3489 administers to the patient, it may be denied by the insurance or non-covered.  

HCPCS J3489 allows for a repeat after seven days period to treat hypercalcemia of malignancy.

Documentation requirements of Zoledronic acid J code J3489 include eligibility diagnosis for osteoporosis, inadequate circumstances, or treatment via oral or self-administrated drugs, serum creatinine monitors before the administration of the drug, and accountability of patient oral health.

HCPCS J3489 varies in dosage for treatment of disease, such as only 5mg allowed once each year for postmenopausal osteoporosis and men with osteoporosis.

If an IV dosage injects into the patient, 5mg is applicable every two years.

The patient adequately hydrates before the dosage of zoledronic acid, and creatinine should be greater than ≥35 mL/min or better.

Only 5mg of HCPCS J3489 receive in the past year, and infusion was greater than 15 minutes for eligibility.

Zoledronic Acid J Code Examples

The following are examples relevant to zoledronic acid:

Example 1

A 58-year-old male with a PMH of HTN, HLD, and hypothyroidism presents to the hospital outpatient setting because of a headache and high blood pressure before arrival.

The patient lays down in bed at 10 pm and begins having a gradual onset pulsating frontal and occipital headache.

He reports that the pain was very severe.

His headaches are usually associated with HTN. The blood pressure shows a value of 210/100 and denies associated dizziness, chest pain, shortness of breath, motor weakness, numbness/tingling, abdominal pain, nausea/vomiting.

The physician ordered a series of diagnostic tests CT, MRI, and EKG.

EKG was independently interpreted and reviewed by the doctor.

Patient reports improvement in HA with Tylenol. CT of the soft tissue of the neck reveals thyroid cancer.

Laboratory study shows that lower level of calcium in the body.

Physician orders zoledronic acid to treat the abnormal level of calcium in the body

Example 2

A 51-year-old-female presents to the emergency with syncope and has a malignant neoplasm of the liver.

The patient applies a nicotine patch earlier.

The patient had a brief episode of feeling hot, numbness, and tingliness in her b/l hands, “gas discomfort” in her stomach, and headache.

When she tried to get up, she lost consciousness (witnessed by her partner, who I spoke to for more history).

Partner states she was only out for a few seconds before perking up to routine.

Pt states she has had episodes like this in the past but several years ago. No known cardiac history.

Physicians plan to order CBC, CMP, mg, phos, trop, EKG, Tylenol, Pepcid, and Zofran.

Laboratory study shows that lower level of calcium in the body.

Physician orders zoledronic acid to treat the abnormal level of calcium in the body

EKG: Normal sinus rhythm. 70 bpm. No ST elevation or T wave inversions.

CXR: My interpretation showed no acute abnormalities.

Example 3

A 36-year-old male presents to the emergency department with PMH HTN, HLD, Afib (on eliquis), Mitral valve replacement, and gout.

Contributing to the office today for dark blood stools for two days and has gastrointestinal cancer.

He states that he started having diarrhea yesterday and has had 4 BM in the past two days.

The patient denies nausea, vomiting, CP, SOB, dizziness, fevers, chills, and took eliquis this morning.

The physician also notes worsening bilateral lower extremity edema, for which he takes Lasix.

He took Indomethacin for four days for a presumed gout flare. The colonoscopy was done three years ago and found benign polyp but otherwise WNL.

Physician plan to admit and Plan Labs, EKG, CT abdomen, and Pelvis, and prescribed Medicine. Laboratory study shows that lower level of calcium in the body.

Physician orders zoledronic acid to treat the abnormal level of calcium in the body

Example 4

A 56-year-old female with postmenopausal status presents to the office with pain in both upper and lower extremities pain. Pain is constant and gets better for 3 to 4 hours after taking pain medication.

Denies trauma, heavy lifting, palpitations, dizziness, cough, recent illness, fever, chills, back pain, abdominal pain, nausea, recent travel, known sick contacts, current antibiotic use, near-syncope, or syncope, changes in stool color, urinary complaints, or any other symptoms.

The physician ordered a Dexa scan of both upper and lower extremities. Exam revealed that patients have age-related osteoporosis.

The physician prescribed m zoledronic acid as the patient has a lower calcium level in the blood. 

Example 5

38-year-old female past medical history of chronic gastritis diagnosed on endoscopic two weeks ago presenting with one month of on and off palpitations and lightheadedness and has lung cancer.

The patient states that she has been feeling off for the last month and describes her symptoms as when she wakes up in the morning and feels fogginess has bouts of palpitations with associated lightheadedness without syncope.

The patient cannot pinpoint a trigger and states her symptoms resolve on their own.

Palpitations frequently happen everywhere in the body. The patient endorses that she has a healthy diet and does not do any narcotics drink alcohol or smoke.

The patient otherwise denies fevers, chills, syncope, headaches, neck pain, chest pain, shortness of breath, back pain, abdominal pain, nausea, vomiting, diarrhea, and constipation.

The physician decided will obtain EKG labs, chest x-ray reassess

Laboratory study shows that lower level of calcium in the body. Physician orders zoledronic acid to treat the abnormal level of calcium in the body.

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