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Thread: procrit for anemia dx for medicare

  1. #1

    Unhappy procrit for anemia dx for medicare

    AAPC: Back to School
    when using procrit for anemia caused by chemo medications what are the correct anemia codes 285.9 0r 285.3 as per medicare. (or something else) Thank you so much!

  2. #2
    Join Date
    Apr 2007
    Columbia, MO


    The diagnosis is coded as per the physician documentation not per Medicare. If the documentation states it is due to the chemo then it is 285.3 if it is due to the neoplasm it is 285.22. You may not use 285.9 when the documentation is specific.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3

    Default procrit for anemia dx for medicare

    Refer to your area's LCD. In my area, 285.22 does not get paid. Michelle is correct in that you have to go with what your physician's document and if it is an opportunity for them to learn enhanced ways to document, take the time to educate them.

    I have not had a Procrit denial in over 2 months due to educating the physicians on the appropriate documentation.

  4. #4

    Default procrit/medicare clarification

    thank you so much for the prompt response! I did not mean to suggest per medicare and not the doctor. I was asking for clarification that Medicare only pays for 285.9 when procrit is used for chemo/cancer caused anemia - in absence of other anemia dx codes
    Correct coding w/b 285.9, 995.20, Primary condition dx??? Again thank you for your help here

  5. #5


    You would not get paid if you used 285.9. You can also go to the Procrit website and they list codes that meet medical necessity. You need to use 285.3 and the appropriate cancer code. For example 285.3, 162.9 and of course meeting the Hgb values as well.

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