tci ED Coding & Reimbursement Alert - 2004 Issue 4

Reader Question: Consult Hospital Policy for ABN

Question: We have a patient who comes to the ED to receive Procrit injections. His diagnosis is agnogenic myeloid metaplasia (289.89, Other specified diseases of blood and blood-forming organs), which isn't listed as a payable diagnosis on the Medicare local medical review policy for Procrit. He comes in for the injection weekly. How should I report this? And do I need to give him an advance beneficiary notice?      Arkansas Subscriber Answer: On the professional side, the first question you need to answer is whether this patient meets the medical-necessity requirements for a...

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