PROLASTIN-C AND ZEMAIRA

Alpha1-proteinase inhibitors, such Prolastin-C® and Zemaira®, require precise billing and coding in order to be properly reimbursed and to be in compliance. Here are several important rules:
Human alpha 1-proteinase inhibitor injection, 10 mg, HCPCS Code: J0256.
Billing Example: Report 100 units of J0256 for a 1,000 mg (1 g) dose of Zemaira or Prolastin-C.
CPT Administration Codes:
96365: Initial, up to one-hour intravenous infusion for diagnosis, treatment, or prevention.
Usage: Suitable for the first hour of alpha1-proteinase inhibitor 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. Alpha1-proteinase inhibitor therapy is frequently linked to the following codes: E88.01: Alpha-1-antitrypsin deficiency.
Note: The patient's recorded condition should be taken into consideration while choosing the precise diagnosis code.
NDCs, or national drug codes:
Zemaira: o1 g/20 mL: 00053-7201-xx; Prolastin-C: o1 g/20 mL: 13533-0700-xx.
Note: Package variations are indicated by the 'xx' in the NDC.

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: Alpha1-proteinase inhibitors are usually given at 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: Zemaira Coding and Reimbursement Guide: Offers comprehensive Zemaira coding details.

Following these recommendations will make it easier to accurately bill and get paid for Zemaira and Prolastin-C treatments. Consult the specific requirements of each payer and keep abreast of any modifications to coding standards.