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