BENLYSTA

A monoclonal antibody called BENLYSTA ® (belimumab) is prescribed to treat active lupus nephritis and systemic lupus erythematosus (SLE). For proper reimbursement and compliance, accurate billing and coding are necessary. A guide to help healthcare providers is provided below:
Details of the product:
Routes for Administration:
Intravenous (IV) Infusion: BENLYSTA comes in single-dose vials that contain either 400 mg or 120 mg of reconstitution-ready lyophilized powder.
Subcutaneous (SC) Injection: BENLYSTA comes in a 200 mg/mL solution that can be injected once using a prefilled syringe or autoinjector.

Details of the Coding:
HCPCS Codes:
IV Infusion:
J0490: 10 mg injection of belimumab.
Billing Units: Indicate how many 10 mg doses were given. For instance, enter 40 units for a dose of 400 mg.
Belimumab injection, 1 mg, SC Injection: §J0491.
Billing Units: Indicate how many milligrams were given. Enter 200 units, for instance, for a dose of 200 mg.
ICD-10-CM Codes for diagnosis:
Choose the right code according to the patient's condition. M32.9: Systemic lupus erythematosus, undefined is one example.
M32.14: Systemic lupus erythematosus and glomerular illness.The CPT codes for IV infusion are:
96413: Administration of chemotherapy, intravenous infusion; single or first substance/drug; up to 1 hour.
Every extra hour (given individually in addition to the code for the principal procedure) is 96415.
SC Injection: 96372: Subcutaneous or intramuscular injection of a therapeutic, preventative, or diagnostic chemical or medication

Sample Entries on the CMS-1500 Claim Form:
Enter the correct ICD-10-CM diagnosis code (e.g., M32.9) 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: Indicate the relevant CPT code (96413 or 96372) and the HCPCS code (J0490 or J0491) on a different line.
Locator 24E: Make use of Locator 21's diagnosis code.
Locator 24G: Show how many units were given (for example, 40 for an IV dosage of 400 mg).

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.
GlaxoSmithKline's BENLYSTA Billing and Coding Guide is a great source of information and resources.