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Diagnosis billing with J0888

By:  Find-A-Code
Published:  January 9th, 2018

The following information is from LCD L36276.

The diagnosis codes listed below require the use of the EC modifier (ESA administered to treat anemia not due to anti-cancer radiotherapy or anti-cancer chemotherapy) when submitting claims for J0888. In addition, these diagnosis codes are marked with an * indicating they require a dual diagnosis. The dual diagnosis rule is outlined below.

  • D63.1* - Anemia in chronic kidney disease
  • I12.0* - Hypertensive chronic kidney disease with stage 5 chronic kidney disease, or end stage renal disease
  • Hypertensive heart and chronic kidney disease with stage 5 chronic kidney disease, or end stage renal disease
    • I13.11 - Without heart failure
    • I13.2* - With heart failure
  • Chronic kidney disease (CKD)
 

Dual diagnosis rule:

I12.0I13.11I13.2N18.1N18.2N18.3N18.4N18.5, OR N18.9, AND D63.1 MUST BE BILLED TOGETHER.


References:

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