February 2, 2018 at 4:05 pm
#4650
We have had some issues getting infliximab approved for colitis, but as Kathleen said, it is often because the wrong diagnosis code or clinical information is presented. When I have done a peer to peer review because of a denial it has always been approved. Agree that using diagnosis code for colitis helps (K 51.50 has worked for us).
On the other hand, I have not been able to get vedolizumab approved (when a pt is steroid refractory and not improving with infliximab).