HIZENTRA

A subcutaneous immunoglobulin (SCIG) medication called Hizentra® (immune globulin subcutaneous [human], 20% liquid) is prescribed to treat chronic inflammatory demyelinating polyneuropathy (CIDP) and primary immunodeficiency (PI). For proper reimbursement and compliance, accurate billing and coding are necessary. Key Hizentra billing and coding requirements are listed below:
HCPCS Code: J1559: Immunoglobulin (Hizentra) injection, 100 mg.
Billing Example: Since 100 mg is represented by each unit, bill 100 units for a 10-gram (10,000 mg) dose of Hizentra.
NDCs, or national drug codes:
Use the correct NDC for paying for Hizentra, as shown by the product's package. The 11-digit format should be used when reporting the NDC.

Diagnosis Codes: The patient's condition should be reflected in the appropriate ICD-10-CM diagnosis codes. The following codes are frequently linked to Hizentra therapy: D80.0: Hereditary hypogammaglobulinemia.
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.

Administration Codes: After receiving the necessary training, patients or caregivers usually administer Hizentra subcutaneously. However, the following CPT® codes can be relevant if the infusion is given by a medical professional:
96369: Initial, up to one-hour subcutaneous injection for treatment or prevention.
96370: Every extra hour (list separately, along with the primary procedure code).
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.

Additional 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 Hizentra Coding Information supplied by the manufacturer for complete and current details.
Following these recommendations will help ensure that Hizentra therapy is accurately billed and reimbursed.