• Records Request for Lucentis Injections

    Question: For the past 6-8 weeks or so, we have received records requests for all Lucentis injections done for Medicare patients. I hope this doesn’t continue or start to include other drugs.

    Answer: This is a focused medical review audit. Here’s the list of documentation requirements:

    • Beneficiary name and date of service on all documentation
    • Beneficiary weight used to calculate dose given
    • Name and amount of drug administered
    • Signed physician/provider order for the drug
    • Stage of treatment for accurate dose administration
    • Calculation for the drug (i.e., first dose or subsequent dosing)
    • Documentation of administration of the medication
    • Documentation legible and complete (including signature(s))
    • Abbreviate key (if applicable)
    • Relevant history and prior treatment, if needed, to support medical necessity of administration and amount of drug used in administration, which may include documentation (i.e., peer-reviewed medical literature) supporting any off-label use as applicable
    • Initial patient history and physical or initial consultation related to the treatment