J0886 code

LOVE2CODE

Expert
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392
Location
Alexandria, VA
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:cool:Pt has ESRD & Anemia in ESRD using dx codes 585.6 & 285.21.

Per LCD guidelines the dx codes does not support medical necessity.

Please help someone...
 

kbarron

True Blue
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Ossipee, NH
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CMS came out with dx code requirements in Oct. I don't have this info in front of me but go to cms.gov and type in epogen and you should be able to the the covered dx from that. Good luck.
 

mkj2486

Guru
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According to our LCD (WI) 285.21 is the only code needed for J0886. Definitely read the LCD in your area to make sure you are coding the Dx correctly, maybe you do not need the 585.6 or you should be using that as secondary.
 

CC5657

Networker
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You need both the 285.21 & 585.6, in that order. I do charge entry for non ESRD & we have to put in the anemia code first then the stage, plus the EC modifier. You can go to www.procritline.com & check the guidelines for your state.
 

CC5657

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Also, the hemoglobin & hematocrit have to be at certain levels prior to initiation or maintenance of ESA treatment. You can also find this information on the procritline website under national Coverage Determination.

Hope this helps.
 
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