J0885 Questions

pmargets

Networker
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Michigan
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Hello, All -

I just started a new position as a Practice Manager in an Oncology office. I am wondering if I could get some advice on coding J0885 (for Epoetin alfa, non-esrd). We are using the following DX codes:
D64.81
C56.9
T45.1x5

We are getting denials due to being non-covered based on NDC for codes billed.

Any advice?
 

Pam Brooks

True Blue
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Did you add the EA modifier? We do this on the facility side, not sure if you need it on the pro-fee side.
 

donn999

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Tacoma WA
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J0885

Medicare has a transmittal with the instructions and proper coding for this - It is titled ESA Coverage Guidelines. These codes would need to be used for both the drug and for the injections. I tried to upload my copy but it didn't work.. Hopefully you can find it
 
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New Hartford, New York
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J0885 Denials

I am also receiving dx denials for J0885 and I'm appending modifier EC. My dx codes are D63.1 and N18.4. It is being denied for the primary dx code. This denial did not occur with ICD-9 and is a recent ICD-10 dx issue. (I also submit an injection code with N18.4, which is paid). Apparently, the anemia codes aren't primary codes? .... I'll look for the Medicare ESA coverage guidelines as well.
 
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J0885

I am also receiving dx denials for J0885 and I'm appending modifier EC. My dx codes are D63.1 and N18.4. It is being denied for the primary dx code. This denial did not occur with ICD-9 and is a recent ICD-10 dx issue. (I also submit an injection code with N18.4, which is paid). Apparently, the anemia codes aren't primary codes? .... I'll look for the Medicare ESA coverage guidelines as well.

Dx for CKD needs to be primary dx, then D631
 

jbrandt

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Columbus, Ohio
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J0885

Medicare requires a modifier on the J0885 (either EA or EC depending on the indication) & our MAC carrier requires the reporting of the hemoglobin or hematocrit test result. If you're giving it for anemia caused by chemo and/or the neoplasm then use the EA modifier & list the D64.81 first. If it's being given for MDS (myelodysplasia etc) then use the EC modifier & the MDS diagnosis code. If used for CKD report the kidney disease stage (N18.) first & then the anemia due to CKD (D63.1). I would double-check with your MAC carrier regarding the reporting of the HGB/HCT result. Hope this helps!
 

relong

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Bettendorf, Iowa
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I would double check your MAC guidelines. Also, the lab values have to be included on your electronic claim, you may have to have your IT dept contact the EDI dept for your MAC to make sure that information is being put in the correct places.
 
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Good morning,

If the services are for Medicare there are certain diagnosis codes that medicare will not pay if they are listed on the claim. According to Medicare NCD 110.21, diagnosis code T45.1X5A is one of those codes.

I just started a new position as a Practice Manager in an Oncology office. I am wondering if I could get some advice on coding J0885 (for Epoetin alfa, non-esrd). We are using the following DX codes:
D64.81
C56.9
T45.1x5

We are getting denials due to being non-covered based on NDC for codes billed.

Any advice?[/QUOTE]
 

rachaelwilleford

Networker
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Carencro, LA
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If it's based on the NDC (not the NCD), which drug are you using? Procrit or Retacrit? There are certain diagnoses that cannot be used for Retacrit. Procrit on the other hand can be used for all indications. Current article from CMS is A56795
 
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