ORENCIA

For ORENCIA® (abatacept), accurate billing and coding guarantee appropriate reimbursement and compliance. Here are some crucial rules:
Code for HCPCS:
J0129: 10 mg injection of abatacept.
Billing Example: Report 50 units of J0129 for a 500 mg dosage of ORENCIA.

Administration CPT Codes: 96365: Intravenous infusion for diagnosis, treatment, or prevention; initial, up to 1 hour.
Use: Suitable for the first hour of ORENCIA's intravenous infusion.
96366: Intravenous infusion for diagnosis, treatment, or prevention; every hour.
Usage: After the initial hour of infusion, report for each extra hour.
Codes for diagnosis:
The patient's condition should be reflected in the appropriate ICD-10-CM diagnosis codes. The following are typical codes linked to ORENCIA therapy:
M05.79: Multiple sites of rheumatoid arthritis with no involvement of organs or systems.
M06.09: Multiple locations of rheumatoid arthritis without rheumatoid factor.
Unspecified juvenile rheumatoid arthritis, unidentified location (M08.00).
Note: The patient's recorded condition should be taken into consideration while choosing the precise diagnosis code.

The NDC for ORENCIA is 00003-2187-xx, which is a 250 mg single-use vial.
Billing considerations: Drug Waste Reporting: Report any drug that is thrown away from single-use vials using the JW modifier. In the patient's medical file, note the dosages that were given and discarded.
Location of Service: ORENCIA is usually given in a doctor's office that is prepared to handle infusion treatments or an outpatient hospital.
Records: Keep thorough medical records that cover the diagnosis, course of therapy, dosage, administration method, and any medication waste. This paperwork helps with the processing of claims and shows medical necessity.

Other Resources: ORENCIA Access & Support: Provides assistance to healthcare practitioners, such as aid with prior authorization, benefits verification, appeals, coding and billing details, and specialty pharmacy choices.
Following these recommendations will make it easier to accurately bill and get paid for ORENCIA therapy. Consult the specific requirements of each payer and keep abreast of any modifications to coding standards.