ASCENIV

A 10% liquid intravenous immunoglobulin called ASCENIV® (immune globulin intravenous [human]-slra) is prescribed to treat primary humoral immunodeficiency (PI) in adults and adolescents between the ages of 12 and 17. For proper reimbursement and compliance, accurate billing and coding are necessary. A guide to help healthcare providers is provided below:

Product Details: 5 g/50 mL single-use vial: NDC 69911-0020-05 NDC Codes
NDC 69911-0020-10, single-use vial, 10 g/100 mL
Details of the Coding:
The HCPCS code for the 500 mg injection of immune globulin (ASCENIV) is J1554.
Units of Billing: Indicate how many 500 mg doses were given. For instance, enter 10 units for a dose of 5 g (5000 mg).

Codes for ICD-10-CM Diagnosis:
Choose the right code according to the patient's condition. Among the examples are:
Hereditary hypogammaglobulinemia (D80.0)
D83.9: Unspecified common variable immunodeficiency
CPT Codes: 96365: Intravenous infusion, for treatment, prevention, or diagnosis (name medicine or substance); first use, up to 1 hour
96366: Intravenous infusion for diagnosis, treatment, or prevention (name the drug or substance); every hour after that (list separately in addition to code for primary procedure)

Sample Entries on the CMS-1500 Claim Form:
Enter the correct ICD-10-CM diagnosis code (such as D80.0) in locator 21.
Locator 24A: Indicate the service date.
Enter the place of service code (e.g., 11 for office) in locator 24B.
Locator 24D: Write the relevant CPT code (96365) and the HCPCS code J1554 on a different line.
Locator 24E: Make use of Locator 21's diagnosis code.
Locator 24G: Show how many units were given (10 for a 5 g dose, for example).

Extra Points to Remember: NDC Reporting: Properly format the National Drug Code (NDC) and place it in the shaded section of Locator 24D.
JW Modifier: If relevant, report any amount of discarded medication using the JW modifier.
Payer Policies: As each payer may have different needs, confirm specific coding, coverage, and payment policies with them.
For thorough details and resources, consult ADMA Biologics' ASCENIV Guide to Billing and Reimbursement.
To guarantee correct billing procedures, it is essential to keep abreast of payer-specific policies and any modifications to coding standards.