Wiki Billing Medicare for Iron infusion

[vshubert]

I am trying to submit a claim to Medicare for patient that came to the office and had Iron infusion. The claim CPT codes are 99213 w/25 modifier, 96374, and J1756. The diagnosis code I used is D50.9 and N18.2. Medicare denied J1756 stating it was due to NCD 110.10 Please help!

Thank you in advance.

 

[SharonCollachi]

Have you look at the National Coverage Decision? https://www.cms.gov/medicare-covera...56&ncdver=1&DocID=110.10&bc=gAAAAAgAAAAAAA==&

 

[vshubert]

Have you look at the National Coverage Decision? https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=156&ncdver=1&DocID=110.10&bc=gAAAAAgAAAAAAA==&

I reviewed it and from what I understand I have to use 1 approved anemia code and 1 approved CKD code. However the lowest stage it will pay for is CKD stage 3. But there are times where I have patients that are not CKD pts or they are CKD stage 1 or 2. I am trying to find how to correctly charge for those patients.