Health Information Management

Ask the expert: Can we report CPT code 90772 with a J code?

HIM-HIPAA Insider, July 9, 2007

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Q: Can we report CPT code 90772 with a J code? (e.g., J0881 [injection, darbepoetin alfa, 1 mcg], [non-end-stage-renal-disease use]), used for Aranesp®?

We keep getting a local medical review policy (LMRP) edit stating "no supporting diagnosis" when we report 90772 for a diagnostic, prophylactic, or therapeutic injection, subcutaneous or intramuscular.

A: It is appropriate to report 90772 with J0881. The lack of a medical necessity ICD-9-CM diagnosis code is triggering the LMRP edit. Because different facilities have varying fiscal intermediaries with specific LMRPs, you should contact the manufacturer of Aranesp® for reimbursement assistance. The reimbursement hotline phone number is 800/272-9376. Or, go to www.reimbursementconnection.com. The hotline operator will check your facility's LMRP and the diagnosis codes you need to meet medical necessity.

Editor's note: This question and answer was adapted from the July issue of APC Answer Letter. For more information, click here.



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