We are billing ESA for iron deficiency, 280.9, with J0885 and modifier EC for a non-cancer related diagnosis, yet the claim is still denied, why?
According to the national coverage decision (NCD), any use of ESA, reported with EC modifier with a diagnosis of iron deficiency, will be denied. References: CMS Publication, IOM 100-03, Medicare National Coverage Determinations (NCD) Manual, Transmittal No. 80, Change Request #5818, January 14, 2008, describes the NCD for the use of ESAs in Cancer and Related Neoplastic Conditions. CMS Publication, IOM 100-04, Medicare Claims Processing Manual, Transmittal No. 1413, Change Request #5818, January 14, 2008, describes the coding and claims processing rules for the use of ESAs in Cancer and Related Neoplastic Conditions.
