Polycythemia/esrd

[ajeter]

Has anyone had any issues with ESRD patients coming in for secondary polycythemia? We are having issues with Palmetto recouping payments for CBC, FE lab studies on these patients.

Thanks for any help
Amy

 

[btadlock1]

Has anyone had any issues with ESRD patients coming in for secondary polycythemia? We are having issues with Palmetto recouping payments for CBC, FE lab studies on these patients.

Thanks for any help
Amy

What explanation are they giving for the recoup?

 

[btadlock1]

Another question: Are you using 289.0 as your primary diagnosis on the CBC and FE?

I can understand not paying those for ESRD, but they sound medically necessary for polycythemia. The eitology/manifestation convention doesn't apply here, since the labs are directed at the secondary condition.

 

[ajeter]

yes primary is 289.o secondary 585.6, recoup stating services related to ESRD. We found AY modifier thinking maybe this will need to be attached to the lab services?

 

[btadlock1]

yes primary is 289.o secondary 585.6, recoup stating services related to ESRD. We found AY modifier thinking maybe this will need to be attached to the lab services?

I would try that - it fits.