BIVIGAM

Primary humoral immunodeficiency (PI) can be treated with BIVIGAM® (immune globulin intravenous [human], 10% liquid). For proper reimbursement and compliance, accurate billing and coding are necessary. A guide to help healthcare providers is provided below:
Details of the product:
NDC Codes:
NDC 64208-823-05, single-use vial, 5 g/50 mL
NDC 64208-823-10, single-use vial, 10 g/100 mL

Details of the Coding:
500 mg injection of immune globulin (BIVIGAM) (HCPCS Code: J1556)
Billing Units: Indicate how many 500 mg doses were given. For instance, enter 10 units for a dose of 5 g (5000 mg).
ICD-10-CM Codes for diagnosis: Depending on the patient's condition, choose the right code. Among the examples are:
Hereditary hypogammaglobulinemia (oD80.0)
D83.9: Unspecified common variable immunodeficiency

CPT Codes: 96365: Intravenous infusion, first, up to 1 hour; for diagnosis, prophylaxis, or therapy
96366: Every extra hour (list separately, along with the primary procedure code)

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 J1556 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.