Procrit

[YesicaRuedas]

Hi All,

I have a question regarding lab results when using Procrit. If patient received procrit and their hematocrit and hemoglobin levels are normal for that day but patient lab results in prior visits were abnormal and also received procrit for those dates of service will it be right using prior lab results for procrit or do you have to go by lab results given that day?

Hope it makes sense.

Thanks!

 

[alannae]

I'm not sure I'm clear on the timing of the labs in your question but here's my take on Procrit and labs.

The labs must be within 2 weeks of the date of the injection (per our local LCD).

You should use the most recent lab values PRIOR to the giving of the Procrit AND available when the decision to give the drug is available.

If the lab values are too high, then the treatment is not 'medically necessary'.

If blood is drawn on the date of the Procrit shot but the lab results are not reported (results are not back) when the drug is given, use the previous set of labs (from within the past 2 weeks). If these labs come back and are too high, you may have a problem upon review but you would have the argument that the most recent available labs were within range to show medical necessity.

The bottom line is that you cannot choose to report the labs that show medical necessity. You must report the most current available labs. If the medical personnel gave the Procrit even though the most current labs were too high, then medical necessity is not shown and the provider will most likely be responsible for the loss of the drug.

Clear as mud!