Home Health ICD-9/ICD-10 Alert

Question: Our homecare agency needs to know which diagnoses are approved for B12 injections. I have the guidance from CMS that tells us B12 injections are approved for certain anemias, malabsorption syndromes, etc. But we could use more detailed information.

Answer: Your answer can be found in the Medicare Benefit Manual which advises that:

"Intravenous, intramuscular, or subcutaneous injections and infusions, and hypodermoclysis or intravenous feedings require the skills of a licensed nurse to be performed (or taught) safely and effectively." Medicare will pay for these services when they are deemed "reasonable and necessary to treat the illness or injury." To meet those requirements, the medication you're administering must be accepted as safe and effective for treatment of the patient's illness or injury, and the patient must have a medical reason for being unable to take the medication orally.

Vitamin B-12 injections are considered specific therapy only for the following conditions:

Specified anemias: pernicious anemia, megaloblastic anemias, macrocytic anemias, fish tapeworm anemia;

Specified gastrointestinal disorders: gastrectomy,malabsorption syndromes such as sprue and idiopathic steatorrhea, surgical and mechanical disorders such as resection of the small intestine, strictures, anastomosis and blind loop syndrome, and

Certain neuropathies: posterolateral sclerosis, other neuropathies associated with pernicious anemia, during the acute phase or acute exacerbation of a neuropathy due to malnutrition and alcoholism. The Medicare Benefit manual further advises that a reasonable and necessary dosage schedule for patients with pernicious anemia caused by a B-12 deficiency, would be to receive intramuscular or subcutaneous injections of vitamin B-12 at a dose of from 100 to 1000 micrograms no more often than once a month. "More frequent injections would be appropriate in the initial or acute phase of the disease until it has been determined through laboratory tests that the patient can be sustained on a maintenance dose."

You can read additional details in the Medicare Benefit Policy Manual

Chapter 7 - Home Health Services 40.1.2.4 - Administration of Medications here: www.cms.gov/manuals/Downloads/bp102c07.pdf