Oncology & Hematology Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: Why do I keep getting denials from Medicare for my therapeutic phlebotomy claims? Louisiana Subscriber

Answer: A number of factors could be the source of your denials diagnosis coding confusion being the prime suspect. Many oncology coders make the diagnosis coding mistake of treating therapeutic phlebotomy coding the same as chemotherapy treatment coding and they link the procedure to diagnosis codes for cancer. Check to make sure you're not making the same mistake. Use one of the following diagnosis codes to meet the medical-necessity requirement for a phlebotomy:
238.4 Polycythemia vera 238.7 Other lymphatic and hematopoietic tissues 275.0 Disorders of iron metabolism 277.1 Disorders of porphyrin metabolism 285.0 Sideroblastic anemia 289.0 Polycythemia, secondary. Something else you may want to watch out for when a patient undergoes a phlebotomy is the lack of sufficient documentation. Be sure the patient's record includes details of the condition being treated, the date of the service, and also documentation indicating either the patient's red blood cell mass or pre-phlebotomy hematocrit of greater than 60 percent. These details will substantiate your defense of a denial.