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modifier? - injection my clearinghouse

  1. #1
    Question modifier? - injection my clearinghouse
    Exam Training Packages
    Can anyone help me with an injection my clearinghouse is stating that it need a modifier and I am not sure because this is the first time keying a charge in for this injection. The injection is Aranesp 200mcg hcpc code is J0881. Do anybody know the correct modifier for this injection?


    tdplair

  2. #2
    Location
    Bettendorf, Iowa
    Posts
    133
    Default
    Is it for Medicare? Some carriers require modifiers depending on the circumstance in which you're giving the aranesp (i.e. EC for non-ESRD anemia non-chemo).

    If this is the first time you're submitting charges for an ESA and its for medicare its best to read completely through your LCD. There's alot involved and you'll keep getting denials until you've met all the requirements.

    Good luck!
    Last edited by relong; 04-22-2011 at 12:25 PM.
    Ruth Long CPC,CHONC
    relong@rccqc.com

  3. #3
    Default modifier
    The insurance for this patient is Medicare and he is diagnose with MGUS-IGA(273.1) and MDS(238.75).


    tdplair

  4. #4
    Location
    Bettendorf, Iowa
    Posts
    133
    Default
    http://www.cms.gov/medicare-coverage...=BBAAAAEAAAAA&

    Here is the ESA LCD website for CGBA. You'll need the appropriate anemia dx + the MDS dx. EA modifier if the pts not getting chemo and EC if they're on chemo.
    Ruth Long CPC,CHONC
    relong@rccqc.com

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