Attention Part B Providers Billing for Ozurdex™ with Unlisted Code J3490

Ozurdex was approved for the treatment of macular edema following branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO) on June 17, 2009. Claims with dates of service prior to 6/17/2009 will be denied as noncovered.

Claims with dates of service after 6/17/2009 are payable if the drug was administered to treat macular edema (reported with ICD-9 code 362.83 (retinal edema)). Claims submitted for other indications will be denied as not medically necessary as there are no other FDA-accepted uses for the drug.

For example: Claims containing ICD-9 codes 362.35 (central retinal vein occlusion) or 362.36 {venous tributary (branch) occlusion of retina} as the only diagnosis codes will be denied as Ozurdex is indicated for the treatment of the macular edema caused by the occlusion; not the treatment of the occlusion.

Claims that were incorrectly coded and contain a covered diagnosis of retinal edema (362.83) in the medical records, or suspected of being incorrectly denied despite the presence of the 362.83 code on the submitted claim, must be appealed, as no automated system adjustments will be done for them. Please access the Appeals section of www.NGSMedicare.com for instruction on filing a timely appeal.

Thank you,
National Government Services, Inc.
Corporate Communications

This entry was posted on Monday, February 8th, 2010 at 10:27 am and is filed under MEDICARE UPDATES. You can follow any responses to this entry through the RSS 2.0 feed. Responses are currently closed, but you can trackback from your own site.