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coding for the J0885 (Epogen, Procrit)

  1. #11
    Location
    Columbia, MO
    Posts
    12,844
    Default
    Medical Coding Books
    First. yes you can use V codes as primary dx when the documentation supports the code, there are some V codes that are secondary only, and there are some that are first-listed only, so you need to check the lists in the guidelines to know which. However when you are administering procrit, the physician needs to state the condition for which the procrit is necessary. Most often this is anemia and usually we used anemia unspecified. In chemo patients, the anemia is mostly due to the chemo drugs as opposed to due to the neoplasm, As of Oct 1 a new code was created for chemo related anemia. So the appropriate code to use for patients receiving procrit is the type of anemia documented by the physician. The new code is:

    285.3 Antineoplastic chemotherapy induced anemia
    Anemia due to antineoplastic chemotherapy
    Excludes: anemia due to drug NEC – code to type of anemia
    anemia in neoplastic disease (285.22)
    aplastic anemia due to antineoplastic chemotherapy(284.89)
    from the guidelines:
    Anemia associated with chemotherapy, immunotherapy and radiation therapy:
    When the admission/encounter is for management of an anemia associated with chemotherapy, immunotherapy or radiotherapy and the only treatment is for the anemia, the anemia is sequenced first. The appropriate neoplasm code should be assigned as an additional code.

    Debra A. Mitchell, MSPH, CPC-H

  2. #12
    Default J0885
    I'm not really sure for Ohio. We are using the EA and adding the levels in a value code method. The proper way to enter them all depends on your computer system. Try calling them to see what they are seeing on the claim. They may not be seeing your levels at all. Then you would have to work with your system administrator to obtain a way to add them on the claim. I hope this helps. Good Luck

  3. Default Medicare Denials in Error for J0885
    Good Afternoon

    We had the same issue here with denials on our J0885 procedures come to find out Medicare denied them in error, Medicare stated that they will be reprocessing all of J0885 that were denied in error for payment.

    Hope this helps
    Margie

  4. #14
    Location
    Seacoast- Dover New Hampshire
    Posts
    609
    Default
    Margie, who is you FI? We have been having trouble getting pd.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  5. Default for the OP
    We are also in Ohio and bill J0885 with anemia primary, cancer secondary per Palmetto guidelines and have no problem with our claims. We are also using the -EA, -EB or -EC modifier as appropriate and reporting the last HCT in Block 19 (or the electronic equivalent). Hope this helps!

  6. Default
    The modifers are correct at EA and EC...for the H/H, put it this way on the claim.

    *09.9 20091029

    That should work

  7. Default
    We have been getting denials for J0881. According to documentation, several of our patients receive it for anemia due to chronic renal insufficiency.
    585.9, 285.21 are the codes used and our pharmacy adds the EC or EA. We also make sure the H & H are entered. Has anyone else ran into this? I thought we were following the guidelines. Could it be because we are not a dialysis facility, we are a hem/onc hospital outpatient department

    When our billing department called the carrier, she spoke to 3 different people and received 3 different answers. There has to be a way for everyone to get on the same page.

  8. #18
    Default More confusion on the J0885
    Someone please help:

    We are receiving denials for the J0885 injection. The patient is receiving the injection at the same encounter of the chemotherapy. The pt has developed the anemia due to the chemotherapy. The Hemocrit/Hemoglobin have been docuemented and the claim is also being billed with the EA modifier. We are a hospital based facility and the chemo and injections are billed by the hospital and on a UB-04. So we cannot link diagnosis to procedures. The diagnosis are billed in the same order for each line item. The reason for the visit is the chemotherapy (V58.11) as we are using this as the prime diag. The second diag we are using is the neoplasm ex(182.0) and finally the third diag we are using is the anemia (285.29). Is this the correct way of billing for this scenerio. Please help
    Thank you in advance,
    Kristen Richard, CPC
    Kristen Richard, CPC

  9. #19
    Location
    Grand Rapids, MI
    Posts
    57
    Default
    Coding aranesp/procrit is as follows:

    chemo induced 285.3
    anemia due to CKD 585._/285.21
    MDS 285.9

  10. #20
    Default
    I'm sorry abc....I am not sure what you are saying. Pt is coming into out facility for chemotherapy. Visit is not to address anemia. Why wouldn't you use the V58.11 as the prime diag. I am confused???????
    Kristen Richard, CPC

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