J0885

Is anyone else having reimbursement unit issue's for J0885 for 2011 ?

re: J0885

Oh yes. ESA denials are running rampant in our Oncology/hematology clinic. The problem as far as I can tell due to lack of documentation. I have researched the ESA guidlines extensively, and as a coder understand exactly what is needed to support the services. What I can not do is get our Providers and their staff to understand that CMS is really not interested in the overall "clinical" picture. I can read the charts, evaluate the lab values, and draw clear conclussions. I can NOT code this. I am trying to gently get them to understand what I need for proper coding/reimbursment, and as scrutiny becomes tighter and more rigid, I as a coder, am not willing to compromise, and without supporting documentation, I will NOT code for payment. As ICD-10 draws near, this is only going to get worse, and it would benefit all, if my gentle quidence would be taken seriously.