Wiki Aranesp/Procrit and Iron Deficiency Anemia

[Shelly7169]

I need clarification. On reviewing the NCD and LCD for ESAs (aranesp/procrit) I am very confused when it comes to the diagnoses and what has to be reported. We have several nephrology patients that are being treated for Iron Deficiency Anemia and also have anemia due to chronic Kidney Disease.

The pt's are NOT receiving the ESA's for the Iron Deficiency Anemia, but for the Anemia due to Chronic Kidney Disease.

Normally, we would not code a condition that is not being treated at that encounter. In the past, we would treat the pt's iron deficiency anemia with an infusion on one day and then another day would administer the ESA injection.

From what I am reading....does Medicare require the iron deficiency anemia be listed on the claim for the Aranesp or Procrit just because they have it as an active diagnosis, even if it is not being treated that day? We are confused in my office and need clarification.

What are your thoughts? How do you handle this in your office?

Thank you,

Shelly Noll, CPC
Rockwood Clinic
534 E. Spokane Falls Blvd. #300
Spokane, WA 99202
(509) 342-3646

 

[LTibbetts]

That's how we do it where I work. The chronic anemia is first, then the CKD (staged) and then any other chronic condition (ie, iron deficient anemia).

In order for the aranesp/procrit to be covered, the anemia code has to be primary, then the CKD, which has to be staged, and then a V code if the patient is also having chemo. I don't do the injection/chemo coding here where I work, but I do help my supervisor with them from time to time, and I did go and ask her just now before I answered you to make sure that what I tell you is accurate. Keep in mind that I do work at a critical access hospital and my supervisor stated that this is the case, regardless.

I also took another look at the coding guidelines for outpatient theraputic services and I guess that technically, the code that brings the patient in for treatment in the first place should be listed as the primary dx, but it would be my personal belief that the iron deficient anemia is ultimately caused from the CKD and chronic anemia in the first place so the iron deficiency could be coded as a secondary dx with the 285.21 as the primary dx.

So, I guess, in lies the dilemna that you are referring to. First, I think that I would talk to the provider directly if you can, and ask them what they think about it and take it from there, and then also talk with your HIM director, if you have one, or whoever is your coding supervisor...I guess that is what I would do if it were me. I certainly wouldn't want any part of any fraudlulent activities, as I am sure you don't either, but it does cause a sort of conundrum doesn't it? Hopefully, you'll get more responses from this forum as well.

I am not sure if this is what you needed to know or if it even helps, but I hope it does. Maybe there is someone else in this forum who has a little more to add with a lot more experience in this matter. Good luck!

 

[rross]

aranesp denials

I work in Hem/Onc and we have recently had several denials for Aranesp and Procrit. The billing dept. sent in appeals, however the claims were just reprocessed and denied again. Since they were reprocessed, can they be appealed? And if they can, does anyone have any tips on how to get reimbursed?

I am still fairly new at all of this, so any help is greatly appreciated.

 

[cntrycmfort]

We use 285.21 as the 1st Dx and then the CKD stage level 3 or higher. You also need to report the hemoglobin(for Georgia at least)