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Wiki How to bill for procrit

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wlpadgett

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Milan, GA
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I just started to work with a nephrologist and they are not getting paid for procrit injections. What is the correct way to code for 20,000 units of procrit. Most of the patients have CKD. Thanks for any help with this.
 
The first place I would suggest to start is to read the CMS LCD in it's entirety as there are specific diagnosis and modifiers that are needed when Procrit is administered. Or go to your local MAC and see if they have one also. Some commercial carriers have an LCD also that is a little bit different, so double check those too. Without more information it's hard to know why they are not getting paid.

LCD ID
L29168

LCD Title
Erythropoiesis Stimulating Agents
 
I agree that more information is needed to be able able to assist you better. How is it being billed and what does the denial state? Is the denial always the same?, are all the claims billed the same way?
 
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