COSENTYX

An interleukin-17A (IL-17A) inhibitor called COSENTYX® (secukinumab) is prescribed for a number of inflammatory diseases, such as active psoriatic arthritis, active ankylosing spondylitis, moderate to severe plaque psoriasis, and non-radiographic axial spondyloarthritis. Accurate reimbursement and compliance depend on proper billing and coding. A guide to help healthcare providers is provided below:
Details of the product:
Management:
Subcutaneous (SC) Formulation: injected subcutaneously with a Sensoready® pen or a prefilled syringe.
Intravenous (IV) Formulation: For some indications, administered by intravenous infusion.

Details of Coding: HCPCS Codes:
Subcutaneous Administration: According to the most recent information, the subcutaneous formulation of COSENTYX does not have a unique HCPCS code given to it. For information on proper coding guidelines, providers should check with specific payers.
Intravenous Administration: J3247: Intravenous injection of secukinumab (1 mg). This permanent J-code will be used for all places of care as of July 1, 2024.

Billing Units: For every 1 mg of secukinumab administered, report 1 unit. A dose of 300 mg, for instance, ought to be billed as 300 units.
CPT Codes:
Subcutaneous Administration: 96372: Intramuscular or subcutaneous injection for therapeutic, preventative, or diagnostic purposes.
Intravenous delivery: 96413: single or first substance/drug, intravenous infusion, chemotherapy delivery, up to 1 hour.
Every extra hour (given individually in addition to the code for the principal procedure) is 96415. ICD-10-CM Codes for diagnosis:
Choose the right code according to the patient's condition. Psoriasis vulgaris (L40.0) is one example.
L40.50: Unspecified arthropathic psoriasis.
Ankylosing spondylitis of unknown locations in the spine (M45.9).
M46.80: Unknown inflammatory spondylopathy, unknown location.
NDCs, or national drug codes:
Intravenous Administration:
10 digits: 0078-1168-61
11-digit format: 1168-61-00078

Sample Entries on the CMS-1500 Claim Form:
Enter the correct ICD-10-CM diagnosis code (such as L40.0) 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 (such as 96413 for IV infusion) and the relevant HCPCS code (such as J3247 for IV administration) on a different line.
Locator 24E: Make use of Locator 21's diagnosis code.
Location 24G: Show how many units were given (for example, 300 for a 300 mg IV dose).

Extra Points to Remember: ·NDC Reporting: Properly format the National Drug Code (NDC) and place it in the shaded section of Locator 24D.