Wiki ESAs in non-ESRD

[sondra hayden]

I need help with determining the truth of a statement regarding ESA medical necessity in the outpatient hospital area vs physician office. A practice manager told me that the Hgb and Hct levels that support medical necessity are different in the office vs OPPS setting. Does anyone have information to support this? I have read transmittal L25211 and don't see any distinction. This transmittal was effective 1/1/2009. Please give a reference document if available.

Thanks for your assistance.

Sondra Hayden,CPC
802-371-4229
sondra.hayden@cvmc.org

 

[kbarron]

There's is a new one dated 4/1/09. I don't see where the difference would be. We use the last CBC to determine HCT & HGB. We are having trouble getting paid in the office setting. I believe that we would have to be an End Stage Renal Facility approved by Medicare to administer these shots. Our issue is where we are is difficult for some folks to travel to get this medication. Is this considered a Pt D drug? Our office supplies this.