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Preoperative Anemia diagnosis code

Vickie Posted Thu 03rd of January, 2013 15:08:16 PM

A patient with iron deficiency anemia secondary to chronic blood loss 280.0 and stage II chronic kidney disease 585.2 presents to office for a procrit injection given for preoperative surgery of shoulder. Need a diagnosis code for preoperative anemia. Can diagnosis codes 280.0, 585.2, and 285.21 be used?
Thank you :)

SuperCoder Answered Mon 07th of January, 2013 21:23:09 PM

Agreed you with the combination.There is a diagnosis code for anemia in ESRD: 285.21 (anemia in ESRD).

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).

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