Question:

Our cancer center sees a lot of patients with a diagnosis of anemia in chronic kidney disease (CKD). These patients come to the cancer center for Procrit injections. We want to verify if it is appropriate to bill J0885 for the Procrit and a diagnosis code of D63.1 (anemia in CKD) along with the CKD. We were told that only a nephrologist should bill D63.1 along with the J0885. There is no mention of this in national coverage determination (NCD) policy 110.21 (ESAs in cancer and related neoplastic conditions). Please verify if this information is correct.

Answer:

Neither NCD policy 110.21 nor the Medicare Claims Processing Manual (sections 80.8–80.12) contain information specific to physician specialty. Institutional and outpatient providers may bill ICD-10-CM diagnosis code D63.1 with an applicable CKD diagnosis code when documentation is present in the medical record. Per coding guidelines, the Medicare Administrative Contractors (MACs) require the CKD diagnosis to be listed first with the anemia diagnosis code listed secondarily.

For this information, go to the following sources: https://www.cms.gov/Medicare/Coverage/CoverageGenInfo/esapolicies.html and https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c17.pdf.

Facebook
Twitter
LinkedIn
Email
Print

CPT® copyright 2021 American Medical Association (AMA). All rights reserved.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

CPT is a registered trademark of the American Medical Association.