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need help

Mariana Posted Thu 16th of February, 2012 22:07:03 PM

(J0885-GS) being denied by medicare we bill with dx 285.21, 585.4 what am i missing? thanks in advance

SuperCoder Answered Thu 16th of February, 2012 22:20:20 PM

Hi Mariana.
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Is this being used for patients with ESRD who are not on dialysis or for non-ESRD patients? Can you also tell me where you are located so I can look up your LCDs?
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Best,
Leesa
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Leesa A. Israel, BA, CPC, CUC, CMBS
Executive Editor, The Coding Institute
Email: leesai@codinginstitute.com

Mariana Posted Thu 16th of February, 2012 23:15:56 PM

yes, and i am in California thanks for your help..

SuperCoder Answered Thu 16th of February, 2012 23:49:16 PM

I'm not quite sure which part you're saying yes to: patients with ESRD who are not on dialysis

OR

for non-ESRD patients?

Mariana Posted Fri 17th of February, 2012 03:28:19 AM

the patient with ESRD not on dialysis

SuperCoder Answered Fri 17th of February, 2012 12:41:31 PM

Hi Mariana.
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I don't see an LCD for California Medicare. From other states' LCDs that I've looked at your dx coding seems appropriate and J0885 does apply for patients with ESRD who are not on dialysis.
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I think perhaps you need to add modifier EC. I found this information on several Medicare sites -- last line pertains (though they weren't for California, I think they may apply):
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Chronic Renal Failure Patients (ESRD on dialysis and ESRD not on dialysis)

For the purpose of this LCD, the term “not on dialysis” refers to patients that are not on a regular course of maintenance dialysis. For patients who need occasional “rescue dialysis”, it would be appropriate to bill J0881 or J0885, since these patients are not on a regular course of maintenance dialysis.

For patients with ESRD who are on dialysis, a diagnosis of 285.21 and a diagnosis of 585.6 must be billed with procedure code J0882 or J0886.

For patients with ESRD who are not on dialysis, a diagnosis code of 285.21 and a diagnosis of 403.01, 403.11, 403.91, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 585.1, 585.2, 585.3, 585.4, 585.5 or 585.9, must be billed with procedure code J0881 or J0885. The EC modifier is also required.

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Here is one link that may help: https://www.cms.gov/medicare-coverage-database/lcd_attachments/29168_5/J0881.1_codeguide.htm
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You should take with your carrier to see if you need modifier EC or if there's some other reason the claim isn't going through.
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I hope this helps.
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Best,
Leesa

Mariana Posted Fri 17th of February, 2012 17:03:07 PM

thanks for all your help...I will try EC modifier ..

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