astellasreimbursement

Payers may require healthcare providers to submit medical documentation along with claims submitted for services rendered to a patient. Additionally, healthcare providers may be expected to maintain specific types of documentation in the patient's medical record to be submitted to the payer for review upon request.

Maintaining and submitting proper medical documentation, as required by a payer, is an important part of managing the reimbursement process and helping to secure appropriate payment for services rendered.

Below is a list of commonly requested medical documentation that may be requested when treating patients with Adenoscan.

Common documentation on or with Adenoscan claims submission

• ICD-9 diagnosis codes that justify need for Adenoscan
• The cardiovascular nuclear medicine code, the radionuclide, Adenoscan, and the cardiac stress test code may have to be billed on the same claim form

Common medical records documenting medical necessity for Adenoscan

• Clinical diagnosis and specific reason for the study
• Formal interpretation and report of the service
• Results of pertinent diagnostic tests or procedures
• Healthcare provider's referral order, including medical indication for the use of Adenoscan
• Patient weight, to support dosing calculations
• Documentation that patient is unable to perform exercise stress testing, including history and physical examination findings supporting reasons for inability to exercise
• Examples of appropriate reasons for use of pharmacologic stress agents provided in coverage policies include patient conditions (eg, arthritis, amputation, severe peripheral vascular disease, severe chronic obstructive pulmonary disease, baseline left bundle branch block of unknown origin) or for patients taking certain types of medications (eg, beta blockers)
• Drug lot number
• Date the drug was ordered, when it was received by the provider, and the date it was administered to the patient