Wiki Epoetin J0885

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kendalb

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We are seeing denials for Epoetin J0885 when we dose above 60,000 units. I cannot find any information, and I have searched relentlessly, on why we are paid for 60 but not 80. Have any of you seen this or have any
recommendations for proving medical necessity proactively rather than in response to a denial?
 
Surgery

• A patient is taken to surgery for I&D and wound vac placement. Once the patient has undergone anesthesia and in the OR room, the doc determines the wound has healed more than expected since the prior visit and only swabs the wound for a culture.
1. Can you charge for the I&D and append a modifier? If so which modifier?
2. If you can’t charge the procedure, how do we bill for other services leading up to a procedure that wasn’t completed? Won’t MCR deny all other charges without and actual surgery to associate those charges to?
 
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