CIMZIA

A tumor necrosis factor (TNF) inhibitor called CIMZIA® (certolizumab pegol) is used for a number of inflammatory diseases, such as Crohn's disease, rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and plaque psoriasis. Accurate reimbursement and compliance depend on proper billing and coding. A guide to help healthcare providers is provided below:
Details of the product:
Administration: A subcutaneous injection is used to deliver oCIMZIA.
Dosage Forms: 200 mg of certolizumab pegol per milliliter in prefilled syringes.

Details of the Coding:
HCPCS Code: oJ0717: Certolizumab Pegol Injection, 1 mg.
Billing Units: Indicate how many milligrams were given. For instance, enter 400 units for a dose of 400 mg.
CPT Codes: o96372: Intramuscular or subcutaneous injection for therapeutic, preventative, or diagnostic purposes.
Billing Units: For each injection, report one unit. Report each injection using a different unit if more than one is given.

ICD-10-CM Codes for diagnosis:
Choose the right code according to the patient's condition. K50.90 is an example of Crohn's disease that is unidentified and free of consequences.
M06.9: Unspecified rheumatoid arthritis.
L40.50: Unspecified arthropathic psoriasis.
Ankylosing spondylitis of unknown locations in the spine (M45.9).
Psoriasis vulgaris (L40.0).

Sample Entries on the CMS-1500 Claim Form:
Locator 21: Type in the relevant ICD-10-CM diagnosis code (K50.90, for example).
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 (96372) and the HCPCS code J0717 on a different line.
Locator 24E: Make use of Locator 21's diagnosis code.
Locator 24G: Show how many units were given (400 for a 400 mg dose, for example).

Other Things to Think About:
In the darkened section of Locator 24D, enter the National Drug Code (NDC) in the proper format.
Modifiers:
JW Modifier: If appropriate, use this to report any amount of drugs thrown.
JZ Modifier: Shows that no medication has been given to any patients or thrown away.
Payer Policies: As each payer may have different needs, confirm specific coding, coverage, and payment policies with them.
Consult the UCB-provided CIMZIA In-Office Injection Process Guide for thorough details and resources.