ENTYVIO

Adult patients with moderately to highly active Crohn's disease (CD) and ulcerative colitis (UC) can be treated with ENTYVIO® (vedolizumab), a monoclonal antibody. Accurate reimbursement and compliance depend on proper billing and coding. A guide to help healthcare providers is provided below:
Details of the product:
Management:
The intravenous (IV) infusion is administered over a period of about half an hour.
Subcutaneous (SC) Injection: Self-administered using a prefilled pen.

Details of the Coding: HCPCS Codes: o Intravenous Administration: §J3380 - Injection, 1 mg vedolizumab.
Units of Billing: For every 1 mg of vedolizumab given, report 1 unit. A dose of 300 mg, for instance, ought to be billed as 300 units.
CPT Codes:
Intravenous delivery: 96413: single or first substance/drug, intravenous infusion, chemotherapy delivery, up to 1 hour.
Subcutaneous Administration: 99211-Office or other outpatient visit for the assessment and treatment of a patient who is already established and may not need a doctor's presence.
Codes for ICD-10-CM Diagnosis:
Choose the right code according to the patient's condition. K51.00, or ulcerative (chronic) pancolitis without complications, is one example.
K50.90: Unspecified Crohn's disease with no consequences.

NDCs, or national drug codes:
Intravenous Formulation: 64764-0300-20 in 10-digit format
Formatted in o11: 64764-0300-20
Subcutaneous Formulation: 64764-0108-21 in 10-digit format
Formatted in o11: 64764-0108-21
CMS-1500 Claim Form Sample Submissions:
Locator 21: Type in the relevant ICD-10-CM diagnosis code (K51.00, for example).
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 J3380 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).

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.
See the Takeda-provided ENTYVIO Coding & Billing Reference Guide for thorough details and resources.