Quick Reference Coding Guide
Reclast^® (zoledronic acid) Injection

The following coding applies to claims for Reclast in the hospital outpatient setting, in the hospital-owned ambulatory infusion center and in the physician office setting, as outlined in the table below.

Coding and billing for Reclast

	Coding System	Coding for Reclast
Patient's Diagnosis	ICD-9-CM17	733.01	Senile osteoporosis (postmenopausal women/men)
		(See the following 3 listings)	Low-trauma hip fracture (use both: code for senile osteoporosis & for fracture site)
		733.01 + 733.14	Pathological fracture: Neck of femur
		733.01 + 733.15	Pathological fracture: Other specified part of femur
		733.01 + 820.0-820.9	Fracture due to injury: Neck of femur
		733.09 + E932.0*	Glucocorticoid-induced osteoporosis
		733.90	Disorders of bone and cartilage, unspecified (for the prevention of PMO)
		Primary diagnosis code + V58.65	Prevention of glucocorticoid-induced osteoporosis
		731.0	Paget's disease of bone (osteitis deformans)
Drugs & Biologicals	HCPCS18 (Effective January 1, 2008)	J3488	Injection, zoledronic acid (Reclast) 1 mg
	NDC8	0078-0435-61	5 mg/100 mL
Professional Services	CPT®19 (Effective January 1, 2008)	96365	Intravenous infusion for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour
Hospital Only	Revenue codes20	0636	Drugs requiring detailed coding (required by Medicare for separately billable drugs)
		0250	General pharmacy
		0260	Intravenous therapy

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*Some payers may not require Ecode E932.0 for glucocorticoids causing adverse events in therapeutic use.

NOTE: As of January 1, 2005, Medicare systems reject discontinued codes if the codes were not effective on the date of service. Claims with discontinued codes will be returned to the submitter for correction. Please use current codes and coding references when submitting claims.

Claims for service through December 31, 2007, use Q4095. All claims with dates of service January 1, 2008, or after, use J3488.

The codes in this flashcard are provided only for informational purposes, and their use does not guarantee payment. It is the sole responsibility of each provider to confirm all coding and billing information with specific third-party payers, as policies may differ. It is also the sole responsibility of each provider to determine the most appropriate codes to use when billing to ensure that the coding and billing for all services and products are appropriate and correct. The information contained here is current as of January 2009. The information provided is intended as a convenient summary of pertinent coding information and is not intended to replace these other sources of information.