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J0885 diagnosis - I have a patient

  1. #1
    Default J0885 diagnosis - I have a patient
    Medical Coding Books
    I have a patient with 285.9 and 238.72 diagnosis, hct level is 32.5. I am needing hlep on which modifier to use. EA, EB, or EC. I am getting Medicare denials for co-50 as not medically necessary. Any help?????

  2. Default
    Co 50 is diagnosis not modifier review your LCD for the J code

  3. #3
    Default
    285.9 and 238.72 are payable per lcd, but I am questioning the mod because billing with EB is denied. MDS is caused by radiation and that;s my reasoning for using EB modifier. Is this correct?

  4. #4
    Default
    Check relevant LCD - this is tricky

  5. #5
    Smile Coder3151
    Partha is correct, the LCD is tricky. Here are some hightlights that might help:

    Effective for DOS on or after 1/1/2008, non-ESRD ESA claims that report HCPCS J0881 and J0885 billed with ESA modifier EB (ESA, anemia, radio-induced) will be denied.

    Effective for DOS on or after 1/1/2008, non-ESRD ESA claims for HCPCS J0881 and J0885 billed with modifier EA (ESA, anemia, chemo-induced) for anemia secondary to myelosuppressive anticancer chemotherapy in solid tumors, multiple myeloma, lymphoma, and lymphocytic leukemia will be denied when the reported Hemoglobin is > 10.0g/dL or the Hematocrit reported is > 30.0%, whether the patient is in the initiation phase or maintenance phase of treatment. Also, ESA treatment duration for each course of chemotherapy includes the 8 weeks following the final dose of myelosuppressive chemotherapy in a chemotherapy regime.
    J0885: This list does require a dual diagnosis.

    The following ICD-9-CM codes require the EA modifier and a dual diagnosis:285.3 and one of the following must be billed together: 140.0-149.9, 150.0-159.9, 160.0-165.9, 170.0-176.9, 179-189.9, 190.0-199.2, 200.00-200.88, 201.00-201.98, 202.00-202.98, 203.00-203.82, 204.00-204.92, 209.00-209.03, 209.10-209.17, 209.20-209.29, 209.30- 209.36, 209.70-209.79, 230.0-234.9, 235.0-235.9, 236.0-236.99, 237.0-237.9, 238.0, 238.1, 238.2, 238.3, 238.4, 238.5, 238.6, 238.8, 238.9, or 239.0-239.9

    J0885: This list does not require a dual diagnosis

    The following ICD-9-CM codes require the EC modifier: 238.71, 238.72, 238.73, 238.74, 238.75, 238.76, or 273.3.

    J0885: This list does require a dual diagnosis.

    The following ICD-9-CM codes require the EC modifier and a dual diagnosis (*):285.21* and one of the following must be billed together: 403.01*, 403.11*, 403.91*, 404.02*, 404.03*, 404.12*, 404.13*, 404.92*, 404.93*, 585.1*, 585.2*, 585.3*, 585.4*, 585.5*, or 585.9*.

    285.29* or 285.9* and one of the following must be billed together: 042*, 070.54*, 070.70*, 714.0*, or V07.8*.

    Based on the dx you have given it sounds like Modifier EC is the more appropriate modifier and dx 285.9 give requires an additional dx for which the physician would need to be queried.

    Good luck!

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