Results 1 to 2 of 2

aranesp denials

  1. Question aranesp denials
    Exam Training Packages
    I realize this issue has been addressed many times before, but I would like some help.

    I realize If a patient is receiving iron for iron def and aranesp, the aranesp will not be covered by medicare for any reason. However we are getting repeat denials on a patient who according to her notes is receiving aranesp for MDS and in listed in the active problems is iron def. improved. Am I correct in assuming the claim is being denied due to the iron def, even though it is improved? I once thought it would not be covered if given the same day as iron, but that does not seem to be the case.

    The patient states she will refuse to have the treatment if medicare won't pay. Would hate to see a patient trade her health due to financial concerns

    Any guidance would be greatly appreciated.

  2. #2
    Sioux Falls South Dakota
    Who is your Medicare carrier? I suggest checking out their LCD if they have one. Ours (Noridian) is very specific about tx w/Aranesp or ProCrit, that ESA treatment is excluded where there is a current anemia resulting from iron, folate, and/or B-12 deficiency - they are quoting the NCD here. ICD9 codes 281.0 - 281.9 should not appear on a claim for a patient receivig ESA therapy when these conditions [U]do not underlie and/or are not responsible for the current anemia.[U] So, if the iron deficiency anemia is the reason for the treatment, Medicare will not cover it. Only if the iron deficieny is resolved, or is the result of the ESA therapy (code V58.69) would it be covered.
    Again, go through the NCD and your LCD if there is one very, very carefully. Request assistance from the provider concerning if this was underlying iron deficiency or was the iron deficiency caused by the ESA therapy.
    I hope this helps somewhat.
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

Similar Threads

  1. Aranesp W/E code
    By umcanes4 in forum Hematology/Oncology
    Replies: 1
    Last Post: 12-10-2012, 11:12 AM
  2. ESRD with Aranesp
    By chrisden_7 in forum Urology
    Replies: 2
    Last Post: 07-15-2011, 04:15 PM
  3. Epogen/Procrit/Aranesp
    By shelliet in forum Diagnosis Coding
    Replies: 2
    Last Post: 04-06-2009, 02:07 PM
  4. Aranesp J0881
    By JBJ in forum Medical Coding General Discussion
    Replies: 4
    Last Post: 10-21-2008, 08:06 AM
  5. billing aranesp/procrit
    By relong in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 05-02-2008, 10:56 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.