Oncology & Hematology Coding Alert

Question: We're getting denials for our iron injection claims. We're using diagnosis code 280.0. Do you have any advice?

Ohio Subscriber

Answer: Typically, the nurse injects iron in patients with iron-deficiency anemia who are also receiving chronic hemodialysis and Epogen therapy. But CMS offers a number of ICD-9 codes to prove medical necessity; therefore, check with your local carrier to determine the accepted diagnosis code.

One problem could be that 280.0 (Iron deficiency anemias; secondary to blood loss [chronic]) is not specific enough for your carrier. Another option may be a malignant neoplasm code, such as 151.0 (Malignant neoplasm of stomach; cardia). Be aware that a covered diagnosis code alone does not guarantee Medicare payment. For instance, you should avoid submitting your claim without the physician's or qualified nonphysician practitioner's UPIN.