CINQAIR

Patients with severe asthma and an eosinophilic phenotype who are 18 years of age or older may benefit from additional maintenance treatment with CINQAIR® (reslizumab), an interleukin-5 antagonist monoclonal antibody. For proper reimbursement and compliance, accurate billing and coding are necessary. The main CINQAIR billing and coding criteria are listed below:
HCPCS Code: J2786: Reslizumab injection, 1 mg.

Purchase and Bill
Billing Example: Since one unit is equivalent to one milligram of CINQAIR, bill 100 units for a 100 mg dose.
CINQAIR 100 mg/10 mL single-use vial; National Drug Code (NDC): 593110-0610.
Codes of Administration:
96365: Initial, up to one-hour intravenous infusion for diagnosis, treatment, or prevention.
Chemotherapy administration, intravenous infusion technique; single or first substance/drug; up to 1 hour. (96413).
Note: The particular clinical situation and payer guidelines determine which of these codes should be used. Chemotherapy administration codes may be required by certain payers that view CINQAIR administration as complicated.

Diagnosis Codes: The patient's condition should be reflected in the appropriate ICD-10-CM diagnosis codes. Common codes for CINQAIR include:
J82: Eosinophilia in the lungs, not else classified.
J45.50: Uncomplicated severe chronic asthma.
J45.51: Acute aggravation of severe chronic asthma.
J45.52: Status asthmaticus with severe, ongoing asthma.

Additional Billing Considerations: Pre-Authorization: Prior authorization is required for biologic medicines such as CINQAIR by many insurance companies. Before starting treatment, make sure that all required approvals have been received.
Documentation: Keep thorough medical records that include the diagnosis, treatment plan, dosage, administration route, and specifics of the administration. This paperwork enables efficient claims processing and substantiates medical necessity.