Aranesp® (darbepoetin alfa)

Coding Contents:

+ Coding for Physician Office Setting

Item Coding Guidance (HCPCS1/CPT®2/
ICD-9-CM3)
Notes

Aranesp® (darbepoetin alfa) HCPCS Coding

J0881, Injection, darbepoetin alfa, 1 mcg (non-ESRD use)

 

ESA Modifiers4

EA: ESA, anemia, chemo-induced
EB: ESA, anemia, radio-induced
EC: ESA, anemia, non-chemo/radio

Claims submitted without one of the ESA modifiers will be returned to the provider

Hemoglobin (Hb)/ Hematocrit (Hct) Level5

Report Hb and/or Hct test results in box 19 of the CMS-1500 claim form (or electronic equivalent)

Claims submitted to Medicare without Hb/Hct information will be returned to the provider

Drug Administration

96372, Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular

96372 replaced 90772 as of January 1, 2009. The code descriptor remains the same.

Office Visit

Relevant Evaluation and Management (E&M) code6,7

See payor guidelines

Diagnosis/Condition

Appropriate ICD-9-CM code(s) for patient condition

Example: 285.21, Anemia in chronic kidney disease

1 HealthCare Common Procedure Coding System.

2 Current Procedure Terminology (CPT). CPT codes® 2008 American Medical Association (AMA). All rights reserved. CPT is a trademark of the AMA. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.

3 International Classification of Disease, Ninth Revision, Clinical Modification.

4 CMS Publication 100-04: Medicare Claims Processing Manual, Chapter 17: Drugs and Biologicals, Section 80.9: Required Modifiers for ESAs Administered to Non-ESRD Patients.

5 CMS Publication 100-04: Medicare Claims Processing Manual, Chapter 17: Drugs and Biologicals, Section 80.8: Reporting of Hematocrit and/or Hemoglobin Levels.

6 Report relevant E&M code if a separately identifiable E&M service is performed. Document accordingly.

7 Some payors, including Medicare, will not allow a Level 1 office visit to be billed with an infusion code for the same date of service, and only for other levels


+ Coding for Outpatient Hospital Setting

Item Coding Guidance (HCPCS1/CPT®2/
ICD-9-CM3)
Notes

Aranesp® (darbepoetin alfa) HCPCS Coding

J0881, Injection, darbepoetin alfa, 1 mcg (non-ESRD use)

 Report Aranesp® per 1 mcg

Revenue Code

0636, drugs that require detailed coding

Non-Medicare payors may require 0250, general pharmacy

ESA Modifiers4

EA: ESA, anemia, chemo-induced
EB: ESA, anemia, radio-induced
EC: ESA, anemia, non-chemo/radio

Claims submitted without one of the ESA modifiers will be returned to the provider

Hemoglobin (Hb)/ Hematocrit (Hct) Level5

Report Hb and/or Hct test results on the UB-04 using value code 48 for Hb or value code 49 for Hct

Claims submitted to Medicare without Hb/Hct information will be returned to the provider

Drug Administration

96372, Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular

96372 replaced 90772 as of January 1, 2009. The code descriptor remains the same.
Also report revenue code relent for the HOPD cost center

Office Visit

Relevant Evaluation and Management (E&M) code6,7

See payor guidelines

Diagnosis/Condition

Appropriate ICD-9-CM code(s) for patient condition

Example: 285.21, Anemia in chronic kidney disease

1 HealthCare Common Procedure Coding System.

2 Current Procedure Terminology (CPT). CPT codes® 2008 American Medical Association (AMA). All rights reserved. CPT is a trademark of the AMA. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.

3 International Classification of Disease, Ninth Revision, Clinical Modification.

4 CMS Publication 100-04: Medicare Claims Processing Manual, Chapter 17: Drugs and Biologicals, Section 80.9: Required Modifiers for ESAs Administered to Non-ESRD Patients.

5 CMS Publication 100-04: Medicare Claims Processing Manual, Chapter 17: Drugs and Biologicals, Section 80.8: Reporting of Hematocrit and/or Hemoglobin Levels.

6 Report relevant E&M code if a separately identifiable E&M service is performed. Document accordingly.

7 Some payors, including Medicare, will not allow a Level 1 office visit to be billed with an infusion code for the same date of service, and only for other levels


+ Coding for Dialysis Setting

Item Coding Guidance (HCPCS1/CPT®2/
ICD-9-CM3)
Notes

Aranesp® (darbepoetin alfa) HCPCS Coding

J0882, Injection, darbepoetin alfa, 1 mcg (ESRD use)

Report each administration of Aranesp® on its own line item

Revenue Code

0636, drugs that require detailed coding

Non-Medicare payors may require 0250, general pharmacy

Modifiers

Enter appropriate modifiers, such as -GS, -ED, or -EE4

Visit the CMS Website or the MLN Matters article referenced below for more information on the modifiers

Route of Administration5

Providers are encouraged to include the modifier JA on the claim to indicate an intravenous administration or modifier JB to indicate a subcutaneous administration

Although reporting the route of administration is optional at this time, CMS has indicated that guidance is forthcoming that will require such information

Hemoglobin (Hb)/ Hematocrit (Hct) Level6

Report Hb and/or Hct test results on the UB-04 using value code 48 for Hb or value code 49 for Hct

Hb/Hct levels should indicate the patient's most recent reading taken before the start of the billing period

HCPCS Code for Supplies

Report code A4657 with revenue code 0270 to capture the charges for syringes used in the administration of Aranesp®

Reimbursement for A4657 is $0.50 per use

Diagnosis/Condition

Appropriate ICD-9-CM code(s) for patient condition

Example: 285.21, Anemia in chronic kidney disease; 585.6, end stage renal disease

1 HealthCare Common Procedure Coding System.

2 Current Procedure Terminology (CPT). CPT codes® 2008 American Medical Association (AMA). All rights reserved. CPT is a trademark of the AMA. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.

3 International Classification of Disease, Ninth Revision, Clinical Modification.

4 CMS Publication 100-04: Medicare Claims Processing Manual, Chapter 8: Outpatient ESRD Hospital, Independent Facility, and Physician/Supplier Claims, Section 60.7

5 CMS Publication 100-04: Medicare Claims Processing Manual, Chapter 8: Outpatient ESRD Hospital, Independent Facility, and Physician/Supplier Claims, Section 60.2.3.1

6 CMS Publication 100-04: Medicare Claims Processing Manual, Chapter 8: Outpatient ESRD Hospital, Independent Facility, and Physician/Supplier Claims, Section 60.7.1