Results 1 to 5 of 5

procrit for anemia dx for medicare

  1. #1
    Unhappy procrit for anemia dx for medicare
    Medical Coding Books
    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
    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. 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. Default
    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.

Similar Threads

  1. Procrit
    By YesicaRuedas in forum Hematology/Oncology
    Replies: 1
    Last Post: 08-29-2013, 11:26 AM
  2. Aranesp/Procrit and Iron Deficiency Anemia
    By Shelly7169 in forum Medicare Regulations
    Replies: 3
    Last Post: 01-22-2010, 08:24 AM
  3. Procrit modifier EA,EB,EC for Medicare
    By jhack in forum Modifiers
    Replies: 6
    Last Post: 10-29-2009, 09:13 AM
  4. anemia/ckd coding vs anemia/esrd
    By pam powers in forum Diagnosis Coding
    Replies: 1
    Last Post: 11-05-2008, 10:45 PM

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.