Urology Coding Alert

Question: What diagnosis code should be used for anemia in end stage renal disease (ESRD), and how can we bill for treating it?

Kansas Subscriber

Answer: As of ICD-9 for 2001, there is a new diagnosis code for anemia in ESRD: 285.21 (anemia in ESRD). Before this, there was only 285.9 (unspecified anemia).

However, the fact that there is a diagnosis code doesnt necessarily mean that you will be paid separately for managing an ESRD patients anemia. Physicians who are providing dialysis treatment for patients with ESRD have many restrictions on billing for other services for that patient. Physicians who are not providing the dialysis treatment are not subject to these restrictions.

If the anemia is a result of the ESRD, you need to be very careful about whether you can bill for treating it. ESRD services are paid by Medicare and include the treatment of problems that are related to the disease. To bill extra for treating the anemia, you must be the only physician managing this anemia, or you must be treating something other than unspecified anemia. Are you really managing the anemia, or is there something else you need to consider when caring for the patient? Are no other physicians managing this patient? Does your documentation show that the anemia is unrelated to the ESRD? If the answers to these questions are yes, you can bill for a separately identifiable service using an evaluation and management (E/M) code with modifier -25 (significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service).