Reporting Hemoglobin/Hematocrit Test Results: Clarification
The intent of this article is to clarify how to submit hemoglobin and hematocrit test results when billing electronically. It is advised you share this information with your software vendor. The data entered and displayed on your data-entry screen may not be exactly what is being sent to Medicare in the ANSI raw data file.
As reported in the February 2008 Medicare Advisory, effective for services on or after January 1, 2008, the most recent hemoglobin or hematocrit levels must be reported on any claim for a Medicare patient receiving one of the following:
- ESA administrations
- Part B anti-anemia drugs other than ESAs used in the treatment of cancer that are not self-administered
Failure to report these test results will result in your claim being returned as unprocessed.
The instructions for reporting the test results on professional electronic claims (837P) state to report the hemoglobin or hematocrit readings in Loop 2400 MEA segment. The specifics are:
- MEA01=TR (for test results)
- MEA02=R1 (for hemoglobin) or R2 (for hematocrit)
- MEA03= (for the test results). For example: 2400/MEA/TR/R1/27.5
The most recent numeric test results should always be reported as a 3 digit/number (0-9) with a decimal point between the second and third number (NN.N or 12.3). It is very important to note here that the decimal point must be submitted as part of the submitted value.
- If a 3-digit number is being reported (such as 31.2), then 31.2 should be sent
- If a 2-digit number is being reported (such as 4.5), then 04.5 should be sent
- If a 2-digit whole number is being reported (such as 28), then 28.0 should be sent
- If a single decimal position needs to be reported (such as .9), then 00.9 should be sent
- If a 1-digit whole number is being reported (such as 7), then 07.0 should be sent
- If a test result is being reported as 2-digits and 2 decimal places (such as 26.25), then 26.2 should be sent
In summary, the hemoglobin and hematocrit test result number should always be a 4-byte value (three numbers with a decimal point between the second and third number). In other words, these numbers must follow the format of NN.N. If the test result is less than three numbers, then zeroes must be entered in order to ensure the decimal is given in the correct position as is demonstrated in some of the previous examples.
If you have any questions regarding claim submission, please feel free to contact the Provider Contact Center at (866) 332-7025. For technical assistance with electronic claims, please contact our EDI Technical Support area at (866) 308-5438.