If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below..
Medicare is denying these claims for a mod? And or dx code? Does anyone have any information on this code? Is anyone else having issues with this? Any help would be GREAT!!!!
If the claims you are submitting with the "EJ" modifier on them are definitely subsequent (and not initial) claims, the issue may be with some of the diagnosis codes.
Effective 1/1/08 Medicare requires the Modifier EA, EB or EC be applied to this J code. If not on there it willbe denied as unprocessable lacking the required modifiers.
EA = ESA, Anemia, chemo induced
EB = ESA, anemia, radio-induced
EC = Esa, anemai, non chemo/radio
I work in a Nephrology office that give Procrit injections. When we bill a patient with medicare, we use mod. EC with the J0885. If the patient is seeing the doctor, use -25 with the E/M code & EC with J0885. As for the DX codes, we need to use 285.21 as the 1st dx & the renal stage as 2nd code. We never have a problem getting paid.