Oncology & Hematology Coding Alert

Question: My hematologists Venofer claims have been getting denied. Can you confirm the proper HCPCS code?

Florida Subscriber

Answer: The appropriate HCPCS code for Venofer is J1756 (Injection, iron sucrose, 1 mg).

But the HCPCS code may not be the only problem-causer. When you analyze your denials, you also want to be sure that youre meeting your payers coverage criteria. For example, First Coast Medicares Local Coverage Determination (LCD) L29174 states it covers Venofer use:

" as a first line treatment of iron deficiency anemia in patients undergoing chronic hemodialysis who are receiving supplemental erythropoietin therapy

" for iron deficiency anemia in non-dialysis dependent chronic kidney disease patients receiving a supplemental erythropoietin

" for iron deficiency anemia in non-dialysis dependent chronic kidney disease patients not receiving a supplemental erythropoietin.

The appropriate ICD-9 codes will support medical necessity for J1756. First Coast requires a dual diagnosis: a code from 585.x (Chronic kidney disease) and one of the secondary codes for iron deficiency anemia, 280.x (Iron deficiency anemias), must be billed on the claim.

Your documentation needs to reflect the medical necessity requirements and also include target values for hemoglobin, hematocrit, transferrin saturation and/or serum ferritin levels.

Tip: Search coverage determinations at  www.cms.hhs.gov/mcd/overview.asp.

--Technical and coding advice for You Be the Coder and Reader Questions provided by Cindy C. Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Powder Springs, Ga., and past president of the AAPC National Advisory Board.