# Epogen/Procrit



## shelliet (Jul 2, 2008)

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.


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## dmaec (Jul 2, 2008)

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


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## Lisa Bledsoe (Jul 2, 2008)

http://www.cms.hhs.gov/ContractorLearningResources/downloads/JA5699.pdf

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


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## dmaec (Jul 2, 2008)

yup, that's it! that's part of the new thing - and something about a modifier isn't there??


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## Lisa Bledsoe (Jul 2, 2008)

Yep - the modifiers are also listed in the link...


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## jans04 (Aug 29, 2008)

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


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## cgrussell (Sep 27, 2008)

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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