GAMUNEX-C

Idiopathic thrombocytopenic purpura (ITP), chronic inflammatory demyelinating polyneuropathy (CIDP), and primary humoral immunodeficiency (PI) can all be treated with GAMUNEX®-C (immune globulin injection [human], 10% caprylate/chromatography purified).
For proper reimbursement and compliance, accurate billing and coding are necessary. The main billing and coding rules for GAMUNEX-C are shown below: HCPCS Code:
J1561: 500 mg of immunological globulin injection (Gamunex-C/Gammaked), non-lyophilized (liquid, for example).
Note: 500 mg of GAMUNEX-C are represented by each unit of J1561. Thus, you should bill four units for a dose of 2,000 mg.

Therefore, you should bill four units for a dose of 2,000 mg.
NDCs, or national drug codes:
Using the correct NDC based on the product's packaging is crucial when paying for GAMUNEX-C. The 11-digit format should be used when reporting the NDC.
Codes of Administration:
The proper Current Procedural Terminology (CPT®) codes that specify the administration technique should be used when billing for the administration of GAMUNEX-C. Frequently utilized codes consist of:
96365: Initial, up to one-hour intravenous infusion for diagnosis, treatment, or prevention.
In addition to the code for the principal process, each extra hour is listed separately (96366).
Payer criteria and the particular clinical scenario should be taken into consideration while choosing administration codes. To find the correct codes, go to the payer policies and the most recent edition of the CPT® handbook.

Diagnosis Codes: The patient's condition should be reflected in the appropriate ICD-10-CM diagnosis codes. The following are typical codes linked to GAMUNEX-C therapy:
Hereditary hypogammaglobulinemia (D80.0).
Immune thrombocytopenic purpura (D69.3).
G61.81: Demyelinating polyneuritis with chronic inflammation.
Make sure the diagnosis code appropriately describes the patient's condition and substantiates the therapy's medical need.

Extra Billing Considerations: Pre-Authorization: Immunoglobulin treatments must be approved before being covered by many insurance plans. Before starting treatment, make sure that all required approvals have been received.
Records: Keep comprehensive 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.
Consult the manufacturer's GAMUNEX-C Coverage and Reimbursement Guide for complete and current information.