Lisarae1970
Contributor
As I am sure everyone knows, medical nec. for Epogen/Procrit has been targeted by EVERYONE. I code for an Oncology/Hematology clinic in Washington state. I code my pt's treatment monthly, which has created a very high denial rate for my Epo pt's. Example: A pt received iron sucrose injections for the 1st 2 weeks of the month, and then becomes eligible for Epogen in the 3rd week, once the iron deficiency is under control. I would code this 285.29+238.75+280.9. Because my claim has 285.29 as well as 280.9, treatment will be denied! Any idea how this can be avoided? Then, in the following month, my pt is still receiving Epo, in addition to taking oral iron for maintenance. I am still going to code 285.29+238.75+280.9, due to the oral supplements. Again, denial. Can I remove the 280.9 in the following month, as the pt isn't actually being treated on site for deficiency, or would that be construed as coding for payment? There has got to be a way to maintain the integrity of my coding, maintain compliance with CMS, and get paid appropriatly at the same time.....right? HELP!!!