Billing and Coding: Sedimentation Rate, Erythrocyte

This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L34021, Sedimentation Rate, Erythrocyte. Please refer to the LCD for reasonable and necessary requirements. Coding Guidance Notice: It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier. Erythrocyte sedimentation rates performed on rheumatoid arthritis patients to assess for medication adjustments should be billed with the diagnosis code which reflects the medication the patient is receiving. These diagnosis codes are to be billed only for rheumatoid arthritis medication evaluation: T39.4X5A - T39.4X5S for patients receiving antirheumatics such as gold salts. T45.1X5A - T45.1X5S for patients receiving antineoplastic and immunosuppressive drugs such as methotrexate T45.8X5A - T45.8X5S for patients receiving other primarily systemic and hematological agents such as heavy metal antagonists T50.6X5A - T50.6X5S for patients receiving antidotes and chelating agents, such as penicillamine Documentation Requirements All documentation must be maintained in the patient's medical record and made available to the contractor upon request. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.