J1750

Medicare denied for too many units yet they allow 90, we billed 51.
Anyone know why they would deny ? DX 280.9

re: J1750

280.9 is iron deficiency anemia. J1750 describes injection iron dextran.
Medicare has special coverage determinations: Coverage of parenteral iron preparations, CPT/HCPCS codes J1750, J1756, J2916 and J3490 (when used to report ferumoxytol)/Q0138, Q0139 (effective January 1, 2010): Medicare expects that most patients with iron deficiency will not require parenteral iron supplementation. Medicare will cover parenteral iron preparations, but coverage is limited to those iron-deficient patients in whom oral iron or enteral iron therapy has been demonstrated to have been ineffective, or in other clinical circumstances (such as the need for larger iron doses not possible to provide through oral administration or the need for rapid repletion of iron stores in patients with severe symptomatic iron deficiency) in which oral or enteral iron therapy is otherwise unacceptable.
Medicare is establishing the following limited coverage for CPT/HCPCS code J1750:
Covered for:
280.0–280.1--Iron deficiency anemias
280.8–280.9 --Iron deficiency anemias, other, unspecified
How do you know they allow 90? How frequently do you administer this.

re: J1750

Medicare fee schedule says up to 90 mau;
this is first time pt was given this iron dextran

re: J1750

Per Nancy's previous reply, you need to have a second reason documented other than the anemia (tried, could not tolerate oral; intestinal malapsorption due to (X)) to justify IV iron.

re: J1750

Wow, typing badly today. Sorry.

re: J1750

Thanks to you both !