PRIVIGEN

For Privigen® (immune globulin intravenous [human], 10%), accurate billing and coding are necessary for proper reimbursement and compliance. Here are several important rules:
HCPCS Code: J1459: 500 mg intravenous injection of immune globulin (Privigen), non-lyophilized (liquid, for example).
Billing Example: Report 5 units of J1459 for a dose of Privigen that is 2,500 mg (2.5 g).
CPT Administration Codes:
96365: Initial, up to one-hour intravenous infusion for diagnosis, treatment, or prevention.
Usage: Suitable for the first hour of Privigen'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.

Diagnose Codes: The patient's condition should be reflected in the appropriate ICD-10-CM diagnosis codes. The following are typical codes linked to Privigen therapy:
Hereditary hypogammaglobulinemia (D80.0).
D80.1: Hypogammaglobulinemia that is not familial.
D80.2: Immunoglobulin A [IgA] defect that is selective.
D80.3: Immunoglobulin G [IgG] subclasses with selective deficiencies.
D80.4: Immunoglobulin M [IgM] deficiency that is selective.
D80.5: Increased immunoglobulin M [IgM] due to immunodeficiency.
D80.6: Antibody deficiency accompanied by hyperimmunoglobulinemia or immunoglobulins that are close to normal.
D80.7: Infantile transient hypogammaglobulinemia.
D89.2: Unspecified hypergammaglobulinemia.
Note: The patient's recorded condition should be taken into consideration while choosing the precise diagnosis code.

The National Drug Code (NDC) for Privigen 10% 10 g (100 mL) single-use vial is 44206-0430-10.
Privigen 10% 20 g (200 mL) single-use vial 44206-0430-20.
Privigen 10% 30 g (300 mL) single-use vial 44206-0430-30.
Aspects of Billing:
Reporting Pharmaceutical Waste: To report any medicine that is thrown away from single-use vials, use the JW modifier. In the patient's medical file, note the dosages that were given and discarded.
Location of Service: Privigen is usually given in a doctor's office, an outpatient hospital, or a patient's home that is fitted up to handle infusion treatments.
Documentation: Keep thorough medical records that include the diagnosis, treatment plan, dosage, administration route, and any medication waste. This paperwork helps with the processing of claims and shows medical necessity.

Other Resources: Privigen Coding Guide: Provides Privigen billing and diagnosis codes.
Support for healthcare providers is provided by Privigen Connect, which includes alternatives for specialized pharmacies, help with prior authorization, help with appeals, coding and billing information, and benefits verification.
Following these recommendations will make it easier to accurately bill and fund Privigen therapy. Consult the specific requirements of each payer and keep abreast of any modifications to coding standards.