I work in a hospital outpatient Hem/Onc center. We have been having some denials for the ESA's (Aranesp or Procrit). The problem seems to be because of the diagnosis 280.9. Our patient accounts stay open for 3 months at a time or until they become inpatients. It is possible that diagnosis was entered at registration as the admitting diagnosis or a secondary diagnosis, either way, it drops to the claim automatically. Which brings me to my question... How can we get around the claim denial when the doctors have the patients come in on the same day to receive IV Iron and either aranesp or procrit? Correct me if i'm wrong, but if I read and understand the NCD for the ESAs, it states the claim would be denied if there are any codes relating to iron def., etc.
I would be extremely greatful if someone could help shed some light on this.
I would be extremely greatful if someone could help shed some light on this.