Pharmacy Question for the Week of January 29, 2018

Pharmacy Compliance Question of the Week

Question:

On which types of pharmacy claims must hematocrit or hemoglobin readings be reported?

Answer:

Effective January 1, 2008, the following claims must report the most recent hematocrit or hemoglobin reading for all claims billing for the administration of:

  • Erythropoiesis-stimulating agents (ESA) (J0881, J0882, J0885, J0886 and Q4081)
  • A Part B anti-anemia drug (other than ESAs) used in the treatment of cancer that are not self-administered.

For institutional claims the hemoglobin reading is reported with a value code 48 and a hematocrit reading is reported with the value code 49. Claims not reporting a value code 48 or 49 will be returned to the provider, according to section 80.8, chapter 17, Medicare Claims Processing Manual.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.