# Anemia in Chronic Renal Failure codes



## auntiem57 (Jun 26, 2008)

I don't know if you can help with this coding question but I am trying to get an issue solved where I work.

I am an outpatient clinical coder and work in a hospital setting. We have an AIS clinic and patients come in for the epogen injections, I receive my documention through the computer in an orders screen and it says anemia as the dx, although the patient has Chronic Renal Failure the doctor/staff is not stating  it in my orders screen. The problem I have been having is that my supervisor wants me to use the anemia in chronic renal failure code because she says the billing office has to have those codes with this type of injections. She wants me to code it that way just because the patient has CRF. I have told her that if it is not documented by the doctor that I can only code for the Anemia and can code the additional CRF code as the secoundary code. We have gone round and round on this issue. Can you point me in the right direction in getting an answer on paper that I can show her?? or am I way off base. 



Thank you,


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## coder in mo (Jun 26, 2008)

they will need to document that the pt has anemia due to the CKD in order to use the 285.21.


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## mholland (Jun 26, 2008)

*auntiem57*

I also code for outpatient services in a hospital setting, where services rendered are facility charges only on the claim. Ask your manager for your Local Fiscal Intermediary Update from April 2008. Like you I am coder, and expectedto query the ordering physician after the services have been rendered, if the anemia diagnosis does not fall w/in the new guidelines. The problem with this is that an ABN should have been signed by the patient when the order was unpayable to begin with. In the case of the standing order - go back and query the physician - they are hoping that the doctor reviews the guidelines and changes the diagnosis but I would only be allowed to use that going forward on the next visit. Personally the person responsible for getting the correct information is the RN - she usually is the one that reviews the order prior to administering the Procrit/DPA or Aranesp. I believe Medicare's information has a glitch review dx code 258.22 in your coding book - once you receive the FI bulletin review what Medicare describes this diagnosis code to be associated w/hip or knee surgery I guess they decided to rewrite the ICD-9-CM book with out the WHO input.

I will keep you posted and vise versa?

Marybeth


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