Wiki Epogen/Procrit/Aranesp

[shelliet]

Does anyone have any suggestins in order to ensure that our doctors are providing us with coverable diagnosis? We are considering creating a specific ordering form. Has anyone tried this approach? If so, please provide any helpful ideas that you may have. Thanks a bunch!!!!

 

[slruiz]

I hope this helps. At our facility the Aranesp will only get paid if certain rules apply. The medication is very expensive and I beleive these came from CMS.
In order to get paid you must have one of these anemia codes:
Anemia of chronic kidney disease 285.21
Chronic kidney disease must be Stage 3,4,5 addition code and must be coded.If mentioned in the chart the pt is on chronic dialysis ICD-9 assumes this to be ESRD per the index.

anemia due to chemo 284.89
E-code E933.1

The anemia codes must be the primary diagnosis

Hope this helps
Sharon Ruiz RHIT, CPC, CCS-P
President Elect MBS Chapter

 

[CC5657]

Go into http://www.procritline.com/index.jsp. This web site will tell you the codes you need to use & the guidelines. Hope this helps