Procrit/Retacrit and Iron

[mbanerjee]

Hi, I have just joined an Oncology practice and they were told that they cannot bill for Retacrit and Iron on the same day. The HCPCS codes are Q5106 and J1756. I could not find any NCCI edits on the CMS website or on Codify. So, just wondering if I am missing something? Any help will be greatly appreciated. Thank you.

 

[TThivierge]

Hi, I have just joined an Oncology practice and they were told that they cannot bill for Retacrit and Iron on the same day. The HCPCS codes are Q5106 and J1756. I could not find any NCCI edits on the CMS website or on Codify. So, just wondering if I am missing something? Any help will be greatly appreciated. Thank you.

Mbanerjee
You are not missing anything sometimes payers refuse to pay same day OR the medications are the same but differ names OR these meds could contrast in human body OR certain illness cannot tolerate the medications. That is what makes medical coding and billing a career adventure in must follow the instructions given.
Have a good day!
Lady T

 

[mbanerjee]

Thank you so much! And I share your sentiments! I love this adventure!!

 

[tkermode]

Hi, I have just joined an Oncology practice and they were told that they cannot bill for Retacrit and Iron on the same day. The HCPCS codes are Q5106 and J1756. I could not find any NCCI edits on the CMS website or on Codify. So, just wondering if I am missing something? Any help will be greatly appreciated. Thank you.

We bill them on separate claims, because sometimes payers will deny the Retacrit if there is a D50* dx on the claim, even if the Q5106 isn't attached to the D50* dx codes. Retacrit is not allowed for iron deficiency anemia per CMS and most private payers, so putting them both on one claim can cause issues.