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Thread: Procrit J0885 EJ

  1. #1
    Join Date
    Apr 2007
    Location
    Fort Walton Beach, Florida
    Posts
    11

    Question Procrit J0885 EJ

    Promo: Code Books
    Medicare is denying these claims for a mod? And or dx code? Does anyone have any information on this code? Is anyone else having issues with this? Any help would be GREAT!!!!

  2. #2
    Join Date
    Apr 2007
    Location
    Albany, New York
    Posts
    456

    Question

    What is the chart documentation in conjunction with the use of this drug?
    Karen Maloney, CPC
    Data Quality Specialist

  3. #3
    Join Date
    Apr 2007
    Location
    Fort Walton Beach, Florida
    Posts
    11

    Default HI Thank you!!

    It states the mod is wrong -- we were advised to use a EC Mod or a EJ Mod both are not correct.

    The dx codes arange from 238.75, 285.9, 780.79, 208.07, 782.3 and last 250.00

    I'm completely lost on this one I have no idea.

    Thank you for your reply.


  4. #4
    Join Date
    Apr 2007
    Location
    Minneapolis
    Posts
    332

    Default

    Pam Tienter, CPC, COC, CPC-P, CCS-P, CPMA, CPC-I
    AHIMA Approved ICD-10-CM/PCS Trainer
    AAPC National ICD-10-CM Trainer

  5. #5
    Join Date
    Apr 2007
    Location
    Albany, New York
    Posts
    456

    Smile

    Okay........

    If the claims you are submitting with the "EJ" modifier on them are definitely subsequent (and not initial) claims, the issue may be with some of the diagnosis codes.

    http://www.rimedicare.com/provider/v...articleid=3386

    Hope this helps........
    Karen Maloney, CPC
    Data Quality Specialist

  6. #6

    Default

    Effective 1/1/08 Medicare requires the Modifier EA, EB or EC be applied to this J code. If not on there it willbe denied as unprocessable lacking the required modifiers.
    EA = ESA, Anemia, chemo induced
    EB = ESA, anemia, radio-induced
    EC = Esa, anemai, non chemo/radio

    Hope this helps

  7. #7
    Join Date
    Apr 2007
    Posts
    93

    Default

    I work in a Nephrology office that give Procrit injections. When we bill a patient with medicare, we use mod. EC with the J0885. If the patient is seeing the doctor, use -25 with the E/M code & EC with J0885. As for the DX codes, we need to use 285.21 as the 1st dx & the renal stage as 2nd code. We never have a problem getting paid.

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