Wiki CO4 (modifier inconsistent with procedure code) denials for J0885EA

[bearps@comcast.net]

We are currently getting denials for J0885EA, We are using the V58.11, and the cancer code. The patient is receiving chemotheraphy. Has something changed with this modifier/dx code that anyone knows of.

 

[nlaaron]

This is used to treat the anemia caused by either, Chemo, Chronic Renal failure, or MDS. I have a cheat sheet I can send you if you send me your email. The modifiers used depends on what kind of anemia the patient has and you must submit the values for either their hemoglobin or hematocrit. The lab has to be with in 30 days of the the injection. Also, the level of the hgb and hct has to be under a certain amount to qualify. Here is my email address. aaronorl@benefis.org You should try billing it with 285.3 (chemo induced anemia) and make sure your values are being billed correctly.