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J0886 code

  1. #1
    Default J0886 code
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    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...
    Yolanda T. Haskins CPC, CRC, OHCC, AAPC Fellow
    Past AAPCCA Board of Directors 2014 - 2017


    Alexandria, VA Chapter

    ~ Practice Kindness ~

  2. #2
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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.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  3. Default
    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.

  4. #4
    Default
    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.

  5. #5
    Default
    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.

  6. #6
    Smile J0886
    Quote Originally Posted by ka56gwg View Post
    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.
    Thank you everyone for your response.
    Last edited by LOVE2CODE; 04-10-2009 at 01:55 AM. Reason: misspell word
    Yolanda T. Haskins CPC, CRC, OHCC, AAPC Fellow
    Past AAPCCA Board of Directors 2014 - 2017


    Alexandria, VA Chapter

    ~ Practice Kindness ~

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