Oncology & Hematology Coding Alert

Medicare asks for the -most recent- HGB or HCT count. The good news is CMS doesn't expect you to take readings every time you administer ESA. The American Society of Hematology's January 2008 -Practice Update- explains that CMS clarifies this in the 2008 Final Physician Rule.

The requirement is that you report -the most recent- HGB or HCT level. -CMS recognizes that in some instances the same hemoglobin or hematocrit value might be reported on more than one claim,- the -Practice Update- states (www.hematology.org/policy/practice/01242008.cfm).

But be sure you check your local payer policies. For example, Trailblazer's ESA LCD documentation requirements include -pretreatment Hematocrit level obtained within one week of the initial EPO or DPO injection- and -Subsequent Hematocrit levels obtained within two weeks of the next EPO or DPO injection.-

(You can search TrailBlazer LCDs online at www.trailblazerhealth.com.)