B12 Injections

[JennyHHRN]

Is it true that medicare only covers management of monthly B12 injections for those patients with diagnosis of "Pernicious Anemia". I was recently told that an unspecified anemia diagnosis would not qualify a person for home care b12 injections.

While I'm on the question band wagon:

Are V codes going to be mandatory in Oct. 2003, or just a new option to use in the primary dx field?

Thanks to all who respond!!!!

[sb22]

There are a few anemia diagnoses that will allow for b12 injections. Are you doing home health now? If so, there is a guide called the conditions of participation that specifically tell you what diagnoses and how often it can be administered. V codes will be optional (they should be helpful) I think it will allow more flexibility for the primary diagnosis.

[renerian, BSN, RN]

I believe if you draw an H/H, CBC and can show efficacy in treatment you can do it if the client meets other COPS. WE did in 2002 and got it paid for.

renerian

[NRSKarenRN, BSN, RN]

Each Medicare Intermediary has "interpretations" for MC policies.

This is a link to CAHABA's policy re HHA + RN administering B12:

http://www.iamedicare.com/provider/policy/hhab12.pdf

Some causes of vitamin B12 deficiency include pernicious anemia, megaloblastic anemias,macrocytic anemias, fish tapeworm anemia, gastrectomy, some malabsorption syndromes such

as sprue and idiopathic steatorrhea, surgical and mechanical disorders, and certain neuropathies.

Skilled nurse visits to administer Vitamin B12 injections are payable for specified anemias,specified gastrointestinal disorders, and certain neuropathies when there is documentation of

an abnormal laboratory test. These include one of the following lab tests:

* an abnormally low serum B12 (generally below 200 pg/ml)

* an elevated serum methylmalonic acid (MMA) early in the course of vitamin B12 deficiency

* an elevated homocysteine (HCYS) early in the course of vitamin B12 deficiency

* an abnormal Schilling test

When the initial lab values cannot be obtained, a physician's statement is acceptable to support coverage for a non-reversible cause of vitamin B12 deficiency such as pernicious anemia. This

statement needs to be in the medical record and must be available to Medicare on request.

For a patient with pernicious anemia caused by a B12 deficiency, intramuscular or subcutaneous injection of vitamin B12 at a dose of from 100 to 1000 micrograms no more frequently than once monthly is the accepted reasonable and necessary dosage schedule for maintenance treatment. More frequent injections would be appropriate in the initial or acute phase of the disease until it has been determined through laboratory tests that the patient can be sustained on a maintenance dose.

[hoolahan, ASN, RN]

Here is the thing I have always wondered about this. Suppose the doc never ordered the nurse to draw labs, maybe he did them in his office, so how can we be certain the diagnosis is supported by the labs for COPS?? And whose responsibility is it to find out, the agency's or the physician's? He signs the orders, and should be aware of the conditions, but if labs are done in his office, and never sent to the agency, how is one certain??

Has anyone ever been denied reimbursement for B12 inj's??

Good question!!