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  1. Default J0881
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    I am having trouble getting paid for this code, J0881. The doctor is billing this with an office visit only....can someone help me code this correctly and bill it so that I can get paid for the drug.
    Thank you.

  2. #2
    Default DX on J0881
    Are you using the appropriate DX per the LCD?

  3. Default
    Are you using EC or EA modifier?

  4. Default DX and EA
    I am using modifier EA. AND I am using 285.22, 185 and V58.11 for dx.
    Finance Analyst

  5. #5
    Grand Rapids, MI
    Chemo induced anemia requires 285.3 not 285.22. They cannot get chemo for neoplasm related anemia.

  6. #6
    Columbia, MO
    First V58.11 is a first only dx and is used for the encounter for the chemo.
    Also you might be missing info in box 19 per the following:
    Hematocrit or Hemoglobin Reporting
    Effective January 1, 2008, claims for the following must report the most recent hematocrit or hemoglobin
    1. All claims for the administration of an ESA (HCPCS J0881, J0882, J0885, J0886 and Q4081).
    2. All claims for the administration of a Part B anti-anemia drug that is not self-administered
    (other than ESAs) used in the treatment of cancer. (HCPCS codes J1751 and J1752 deleted
    effective 4/1/08, HCPCS code Q4098 replaced J1751 and J1752 effective 4/1/08, J1756, and
    The hematocrit or hemoglobin level should be reported in Item 19 of the Form CMS-1500. The test results
    shall be entered as follows: TR= test results (slash), R1=hemoglobin, or R2=hematocrit (slash), and the
    most current numeric test result figure up to 3 numerics and a decimal point[xx.x]).
    Example for hemoglobin tests: TR/R1/9.0:
    Example for Hematocrit tests: TR/R2/27.0:
    An you need an administration code, not an office visit if the reason for the encounter is for the drug. If not then the ov with a 25 modifier and the injection admin.
    Also per the coding guidelines:
    Code 285.22, Anemia in neoplastic disease, and code 285.3, Antineoplastic chemotherapy induced anemia, may both be assigned if anemia in neoplastic disease and anemia due to antineoplastic chemotherapy are both documented.

    Debra A. Mitchell, MSPH, CPC-H

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