How To Use CPT Code 4172F

CPT 4172F describes the documentation of a patient not receiving erythropoiesis-stimulating agents (ESA) therapy for chronic kidney disease (CKD). This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples.

1. What is CPT Code 4172F?

CPT 4172F can be used to document the absence of erythropoiesis-stimulating agents (ESA) therapy for patients with chronic kidney disease (CKD). This code is used when the provider does not prescribe ESA therapy to treat anemia in CKD patients.

2. Official Description

The official description of CPT code 4172F is: ‘The provider does not prescribe erythropoiesis stimulating agent therapy to treat anemia in a patient with chronic kidney disease, or CKD.’

3. Procedure

1. Providers often prescribe erythropoietin stimulating agents (ESA) to bring the hemoglobin levels within an appropriate range for CKD patients.
2. However, in cases where the provider determines that ESA therapy is not necessary, CPT code 4172F is used to document this decision.
3. This code should be reported when the provider does not prescribe ESA therapy, as documented in the patient’s healthcare record.

4. Qualifying circumstances

Qualifying circumstances for CPT 4172F include patients with chronic kidney disease (CKD) who do not receive erythropoiesis-stimulating agents (ESA) therapy for the treatment of anemia. This code is specifically used to document the absence of ESA therapy in the patient’s healthcare record.

5. When to use CPT code 4172F

CPT code 4172F should be used when the provider determines that ESA therapy is not necessary for the treatment of anemia in a patient with chronic kidney disease (CKD). It should be documented in the patient’s healthcare record that ESA therapy is not prescribed.

6. Documentation requirements

To support a claim for CPT 4172F, the provider must document the following information:

• Confirmation of the patient’s chronic kidney disease (CKD) diagnosis
• Documentation stating that erythropoiesis-stimulating agents (ESA) therapy is not prescribed
• Date of the documentation
• Signature of the provider

7. Billing guidelines

When billing for CPT 4172F, ensure that the documentation clearly states that the provider does not prescribe erythropoiesis-stimulating agents (ESA) therapy for the treatment of anemia in a patient with chronic kidney disease (CKD). This code should not be reported with other codes related to ESA therapy. It is important to follow the specific guidelines provided by the payer when submitting claims for CPT 4172F.

8. Historical information

CPT 4172F was added to the Current Procedural Terminology system on January 1, 2009. There have been no updates to the code since its addition.

9. Examples

1. A provider documents that ESA therapy is not prescribed for a patient with chronic kidney disease (CKD) and anemia.
2. A healthcare professional notes in the patient’s record that ESA therapy is not recommended for the treatment of anemia in a CKD patient.
3. The provider documents that the patient does not receive erythropoiesis-stimulating agents (ESA) therapy for the management of anemia in chronic kidney disease (CKD).
4. A physician notes in the patient’s healthcare record that ESA therapy is not indicated for the treatment of anemia in a patient with CKD.
5. The provider documents that the patient is not receiving erythropoiesis-stimulating agents (ESA) therapy for the management of anemia in chronic kidney disease (CKD).
6. A healthcare professional notes in the patient’s record that ESA therapy is not necessary for the treatment of anemia in a CKD patient.
7. The provider documents that ESA therapy is not prescribed for the management of anemia in a patient with chronic kidney disease (CKD).
8. A physician notes in the patient’s healthcare record that ESA therapy is not required for the treatment of anemia in a patient with CKD.
9. The provider documents that the patient does not receive erythropoiesis-stimulating agents (ESA) therapy for the treatment of anemia in chronic kidney disease (CKD).
10. A healthcare professional notes in the patient’s record that ESA therapy is not recommended for the management of anemia in a CKD patient.