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Internal Medicine Coding Alert

READER QUESTIONS:

Stick With Insurer's Procrit Coding Guidelines

Published on Sat May 28, 2005

Question: How should we report Procrit injections?


Virginia Subscriber


Answer: Coding requirements for Procrit (or epoetin alpha) injections vary widely by state and insurer. Generally for Medicare payers, you should report Q0136 (Injection, epoetin alpha [for non-ESRD use], per 1,000 units) when the internist administers Procrit to treat chronic anemia (281.9). Many commercial carriers accept this code, while others may accept 90782 (Therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular), so be sure to get your carrier's policy in writing.

In addition, Medicare requires physicians to document the following before submitting Q0136:
 

  •  the patient's diagnosis
     
  •  the time, date, route of administration and dosage given (number of units)
     
  •  frequency of treatment
     
  •  the patient's response to therapy
     
  •  date and result of the patient's most recent hematocrit or hemoglobin level prior to Procrit therapy initiation
     
  •  subsequent hematocrit or hemoglobin values
     
  •  prior to initiation of therapy, the date and result of the patient's most recent serum creatinine within the last month (for renal disease)
     
  •  the patient's weight in kilograms.

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