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Epogen/Procrit

  1. Question Epogen/Procrit
    Medical Coding Books
    We have been having a growing problem with Medicare denying our Epogen and Procrit injections. Can anyone please tell me if there is new coding information for this topic. Thank you.

  2. #2
    Location
    Duluth, Minnesota
    Posts
    1,133
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    ohhhhh yes yes - there is! it's on the Medicare LCD site...and i can't access the site right now or I'd explain more - my print out is at the other office - I don't want to relay the wrong info - you'll find the info on the website though

  3. #3
    Location
    Greeley, Colorado
    Posts
    2,045
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    http://www.cms.hhs.gov/ContractorLea...ads/JA5699.pdf

    Try this link - I believe you have to start reporting most recent hct/hgb results.
    Lisa

  4. #4
    Location
    Duluth, Minnesota
    Posts
    1,133
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    yup, that's it! that's part of the new thing - and something about a modifier isn't there??

  5. #5
    Location
    Greeley, Colorado
    Posts
    2,045
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    Yep - the modifiers are also listed in the link...

  6. Smile
    Also make sure you have the right Dx. Medicare is big on denying Procrit & Epgen for the incorrect DX.

  7. #7
    Default
    There are several new guidelines for billing ESA's. The dx code, the modifer, and hemoglobin count. The count must be reported-10 or below for chemo induced anemia and below 12 for renal insufficiency. There are some other dx codes that medicare just doesn't want on the claim at all, like iron deficiency or vitamin deficiency anemia codes. We have had several problems also with the MDS codes whether or not to use the EC modifier or not. We have begun adding it since the claims were being denied by medicare without it. Check Medicare's website under ESAs.

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