Modifiers and test results are among the ‘instant denial’ triggers for these codes.
Whether you search under medical oncology, hematology, or hematology/oncology, J0881 and J0885 rank first and third on the lists of the top 10 codes reported to the CMS database (2009). These J-codes for erythropoiesis stimulating agents (ESAs) carry a heavy load of very specific reporting requirements and volatile reimbursement rates. To be sure your claims for these frequently reported codes are as clean and accurate as possible, apply the tips below.
Learn more: These recently available top 10 rankings are listed in a file posted by Frank Cohen, MPA, principal and Senior Analyst for The Frank Cohen Group. Choose the link for “Top 10 procedure codes by frequency for all specialties” at www.frankcohen.com/html/access.html.
Warm Up With Code and ESA Definitions
The HCPCS codes in focus are as follows:
- J0881, Injection, darbepoetin alfa, 1 mcg (non-ESRD use)
- J0885, Injection, epoetin alfa (for non-ESRD use), 1000 units.
Code J0881 is appropriate to report the supply of Aranesp. Code J0885 applies instead to supply of Epogen or Procrit. Keep in mind that the J codes represent only the supply. You should report the ESA administration separately using 96372 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) for intramuscular (IM) administration, says Janae Ballard, CPC, CPC-H, CPMA, CEMC, PCS, FCS, coding manager for The Coding Source, based in Los Angeles.
Both codes indicate they are specific to “non-ESRD use.” ESRD is short for end stage renal disease. Consequently, these codes are appropriate when the injection is connected to oncologic use.
What ESAs do: ESAs stimulate bone marrow to produce more red blood cells, according to…