Wiki Need Help with Filing Claim to Medicare for Iron Infusion

[vshubert]

I am trying to submit a claim to Medicare for patient that came to the office and had Iron infusion. The claim CPT codes are 99213 w/25 modifier, 96374, and J1756. The diagnosis code I used is D50.9 and N18.2. Medicare denied J1756 stating it was due to NCD 110.10 They say that in order for it to be approved the claim must include both an approved anemia code (D50.9 is an approved code) and an approved CKD code. However their approved CKD stages is CKD3 (N18.3), CKD4 (N18.4), CKD5 (N18.5) and ESRD (End Stage Renal Disease N18.6) The issue is that sometimes patients that receive the iron infusions have either CKD stage 1, CKD stage 2, or not have CKD diagnosis. The way they explained when I called them regarding the denial is that there is no other way to bill and have claims approved unless the above criteria is met. It just seems that there has to be another way to bill if patient does not have CKD or if their stage isn't stage 3 and above. Please help!

Thank you in advance.

 

[SharonCollachi]

Well, it appears that Medicare is telling you that these conditions are the only time they will cover iron infusion. If you didn't get a valid ABN before the procedure was done, then you will be writing it off.

Before any more iron infusions are done, you might want to print up a cheat sheet showing when it is covered by Medicare and when it is not. Then the doctor will know and will be able to talk to the patient about why he thinks they should have it even though they will have to pay for it themselves and the patient will know what it will cost.