Can we report an anemia diagnosis code when billing for myelodysplastic syndrome (MDS)?
Yes. Use the anemia diagnosis that most closely describes the type of anemia the patient has, associated with their MDS. It remains necessary to bill the applicable MDS International Classification of Diseases 9th Review, Clinical Modifications (ICD9-CM) code within the range 238.72-238.75. Additional coverage criteria include: For patients with myelodysplastic syndrome (MDS): 1. MDS with bone marrow blast count of less than 10% blasts. 2. Pretreatment erythropoietin levels less than or equal to 500 IU/L, for ESA therapy initiated on or after the effective date of this LCD. 3. Anemia associated with MDS, with Hb/HCT less than 10 / 30% at initiation of therapy. Treatment with Erythropoiesis Stimulating Agents (ESAs) is given to achieve and maintain a Hb level of 10-12 g/dl.
Yes. Use the anemia diagnosis that most closely describes the type of anemia the patient has, associated with their MDS. It remains necessary to bill the applicable MDS International Classification of Diseases 9th Review, Clinical Modifications (ICD9-CM) code within the range 238.72-238.75. Additional coverage criteria include: For patients with myelodysplastic syndrome (MDS): • MDS with bone marrow blast count of less than 10% blasts. • Pretreatment erythropoietin levels less than or equal to 500 IU/L, for ESA therapy initiated on or after the effective date of this Local Coverage Determination (LCD). • Anemia associated with MDS, with Hb/HCT less than 10/30% at initiation of therapy. Treatment with Erythropoiesis Stimulating Agents (ESAs) is given to achieve and maintain a Hb level of 10-12 g/dl. • The patient must demonstrate a 1 gm/dl sustained increase in hemoglobin when compared to initiation level by the 12th week of therapy.
