KIMYRSA

Adult patients with acute bacterial skin and skin structure infections (ABSSSI) brought on by specific pathogens can be treated with the antibacterial medication KIMYRSA® (oritavancin). For proper reimbursement and compliance, accurate billing and coding are necessary. Here are several important rules:
HCPCS Code: J2406: 10 mg injection of oritavancin.
Billing Example: Since each unit is equivalent to 10 mg, bill 120 units for a 1,200 mg dose of KIMYRSA.
70842-0225-01: KIMYRSA 1,200 mg single-dose vial is the National Drug Code (NDC).

Diagnosis Codes: The patient's condition should be reflected in the appropriate ICD-10-CM diagnosis codes. Common codes for KIMYRSA include:
Erysipelas (oA46).
L03.0: Acute toe and finger lymphangitis with cellulitis.
L03.1: Acute lymphangitis and cellulitis in additional leg areas.
L03.2: Cellulitis and acute lymphangitis of face.
L03.3: Acute trunk lymphangitis and cellulitis.
L03.8: Acute lymphangitis of various locations and cellulitis.
L03.9: Unspecified acute lymphangitis and cellulitis.
Administrative Aspects to Take into Account:
One intravenous dose of KimyRSA is given over the course of an hour.

Additional Billing Considerations: Modifiers: Modifiers like JW (drug quantity discarded/not administered) may be relevant depending on payer restrictions and the particulars of the administration.
Documentation: To prove medical necessity and speed up the processing of claims, keep comprehensive medical records that include the diagnosis, treatment plan, dosage, administration method, and any information on waste.
Consult the manufacturer's KIMYRSA Coding and Billing Guide for complete and current information.
Following these recommendations will help ensure that KIMYRSA therapy is accurately billed and reimbursed.