Author Topic: Procrit (J0885)  (Read 2822 times)

Yesica

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Procrit (J0885)
« on: June 22, 2010, 03:54:00 PM »
I have a question regarding Procrit J0885. This patient came in for an injection of procrit (he has Blue Cross Coverage) but his Hemoglobin is 10.8 and Hematocrit is 33.3 . In the past he had low hematocrit and hemoglobin and it was paid. But can i enter the patients hematocrit and hemoglobin from prior visits for it to be paid? Or is anyone familiar with is? Thanks.

blhoffman

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Re: Procrit (J0885)
« Reply #1 on: June 23, 2010, 07:57:00 AM »
I'm very familiar with this and the rules are long. I will be back and post them.  ;D

blhoffman

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Re: Procrit (J0885)
« Reply #2 on: June 23, 2010, 08:43:50 AM »
OK - I'm back.  ;D

Hi Yesica,

It has to be the most recent before administration.

The Hct and/or the Hgb of the previous or current month. You can only use the previous month if it is the most current and I believe within 30 days of treatment. If any labs were done prior to treatment then the most current taken MUST be the one used. You cannot pick and choose which labs to use in reporting.

oneround

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Re: Procrit (J0885)
« Reply #3 on: June 23, 2010, 01:28:38 PM »
Ditto to blhoffman:

Yessica,

The LCSD for Erythropoietin Stimulating Agents (ESA)  (L27571) has no set crieteria for the EPO injections (verbaige states 'Regular Reporting'.  In our audits we look to obtain the most recent H&H, usually within the last 30 days.  If you are using J0885 then you are treating a pt with CKD not on dialysis in which case  non-ESRD must have

1. Anemia with Hb/HCT less then 10/30% at initionation of therapy.
2. Serum creatinine equal to or greater than 3, creatinine clearance or less then 60 ml/min or glomar filtration rate (GFR) less then 60 mL/min/1.73 m2
3. Iron stores or a MUST and must be documented.  In our audits we have had to reimburese improper payment because there were no iron stores. (This was the number one cause of reimbursment errors in our current audit-No adequate documentation of iron stores.


All above must support a DX of CRF

For pt's ESRD on dialysis you would use your Q4081 code.

I have 53 charts on my desk at this moment in which we are currently auditing procrit (EPO) pts
Michael A. Reynolds, CPC, CCP-P, CPMB, OS
Project Manager
Corporate Compliance
Sharp HealthCare

Pay_My_Claims

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Re: Procrit (J0885)
« Reply #4 on: June 23, 2010, 02:11:22 PM »
you guys continue to impress me........