Wiki Aranesp Billing

[jonestonya324]

Is it ok to code D63.1 (Anemia of CKD) as the primary and N18.4 as the secondary on a Medicare claim for Aranesp?

 

[vanessamoldovan]

Is it ok to code D63.1 (Anemia of CKD) as the primary and N18.4 as the secondary on a Medicare claim for Aranesp?

When I look up the medication on the internet, it shows that it is meant to treat anemia and CKD, so I would assume that Medicare would cover that. But the only way to be sure is to check the Medicare Fee Schedule.

 

[petrichkim]

Is it ok to code D63.1 (Anemia of CKD) as the primary and N18.4 as the secondary on a Medicare claim for Aranesp?

Hello,
see coding note under D63.1 CKD diagnosis should be primary than the D63.1

 

[kathleeng]

Is anyone familiar with the level of CKD required to be with D63.1 for Aranesp? The staff at our oncology/hematology states it must be higher than CKD 3 but the LCD that I have came across, has any level CKD, even unspecified N18.9

 

[trarut]

It's going to depend on payer guidelines. Look for coverage indications in the LCD and review those; don't go just by the listed ICD-10 codes. Our MAC requires level 3 CKD or higher before they will cover Aranesp and they spell out the coverage guidelines pretty clearly in the LCD.

 

[DumindaJ]

There are 2 HCPCS J0881 and J0882

J0881

INJECTION, DARBEPOETIN ALFA, 1 MICROGRAM (NON-ESRD USE)

J0882

INJECTION, DARBEPOETIN ALFA, 1 MICROGRAM (FOR ESRD ON DIALYSIS)

Since your case is non ESRD, I would recommend these codes, J0881, D63.1, N18.4

 

[kathleeng]

It's going to depend on payer guidelines. Look for coverage indications in the LCD and review those; don't go just by the listed ICD-10 codes. Our MAC requires level 3 CKD or higher before they will cover Aranesp and they spell out the coverage guidelines pretty clearly in the LCD.

Thank you! Where do you find the LCD for payer specific? I have been having trouble pulling up all of them, recently.

 

[trarut]

Our MAC - CGS Medicare - has a medical policies page (https://www.cgsmedicare.com/partb/medicalpolicy/index.html) with links over to the current local coverage articles and determinations.

I keep the CMS Coverage Database (https://www.cms.gov/medicare-coverage-database/overview-and-quick-search.aspx) bookmarked and have a list of the Document IDs for the policies we use the most for quick access to the policies I need.