That's how we do it where I work. The chronic anemia is first, then the CKD (staged) and then any other chronic condition (ie, iron deficient anemia).
In order for the aranesp/procrit to be covered, the anemia code has to be primary, then the CKD, which has to be staged, and then a V code if the patient is also having chemo. I don't do the injection/chemo coding here where I work, but I do help my supervisor with them from time to time, and I did go and ask her just now before I answered you to make sure that what I tell you is accurate. Keep in mind that I do work at a critical access hospital and my supervisor stated that this is the case, regardless.
I also took another look at the coding guidelines for outpatient theraputic services and I guess that technically, the code that brings the patient in for treatment in the first place should be listed as the primary dx, but it would be my personal belief that the iron deficient anemia is ultimately caused from the CKD and chronic anemia in the first place so the iron deficiency could be coded as a secondary dx with the 285.21 as the primary dx.
So, I guess, in lies the dilemna that you are referring to. First, I think that I would talk to the provider directly if you can, and ask them what they think about it and take it from there, and then also talk with your HIM director, if you have one, or whoever is your coding supervisor...I guess that is what I would do if it were me. I certainly wouldn't want any part of any fraudlulent activities, as I am sure you don't either, but it does cause a sort of conundrum doesn't it? Hopefully, you'll get more responses from this forum as well.
I am not sure if this is what you needed to know or if it even helps, but I hope it does. Maybe there is someone else in this forum who has a little more to add with a lot more experience in this matter. Good luck!
- ICD-10 Trainings
- Comprehensive Courses
- CPC (Certified Professional Coder)
- COC (Certified Outpatient Coder)
- CIC (Certified Inpatient Coder) NEW!
- CRC (Certified Risk Adjustment Coder) NEW!
- CPB (Certified Professional Biller)
- CPMA (Certified Professional Medical Auditor)
- CDEO (Certified Documentation Expert – Outpatient) NEW!
- CPPM (Certified Physician Practice Manager)
- CPCO (Certified Professional Compliance Officer)
- VIEW ALL CERTIFICATIONS
Coding / Billing Solutions
- Audit / Compliance Solutions
Job Experience / Apprentice Removal
News / Discussion
- Other Resources
- Book Store
- Log In / Join