J0885 with J3420

[ammontagano]

Has anybody recieved denials from Medicare when a Vitamin B-12 is given on the same day as J0885?

 

[daisy3663]

Did you use a -59 modifier for the two separate injections? Medicare denies when we give B12 and Infed on the same day of service.

 

[lpetrova]

Please see Procrit package insert on usage -

"- Evaluate and treat for other causes of anemia:

1) Iron deficiency; 2) Underlying infectious, inflammatory, or malignant processes; 3) Occult blood loss; 4) Underlying hematologic diseases (i.e., thalassemia, refractory anemia, or other myelodysplastic disorders); 5) Vitamin deficiencies: Folic acid or vitamin B12; 6) Hemolysis; 7) Aluminum intoxication; 8) Osteitis fibrosa cystica; or 9) Pure Red Cell Aplasia (PRCA)"

As a routine - before precerting Procrit for CIA - we do iron studies (as well as for CDA - see package insert for guidelines/more info regarding iron studies and creatinine) to have the results on file and to be able to demonstrate to the payer that the patients didn't have underlying anemias prior to chemo treatment. Otherwise, it would be denied.

Best regards,
Lioubov Petrova, CPC

 

[vguyton]

We have to key aranesp/procrit and b12 on two separate claims and add a 76 modifier on the second 96372 before Medicare will pay our claims. CMS told us also that two anemia codes could not be on the same claim with injections and anemia and cancer dx codes could not be on the same claim with injections. Hope this helps.