SAPHNELO

Adult patients with moderate to severe systemic lupus erythematosus (SLE) who are on standard therapy may be treated with SAPHNELO® (anifrolumab-fnia). Appropriate reimbursement depends on accurate billing and coding. Here's a handbook to help medical professionals:
1. HCPCS Code: J0491: Anifrolumab-fnia injection, 1 mg. There are 300 billing units for every 300 mg vial.
2. The National Drug Code (NDC) for this 300 mg/2 mL (150 mg/mL) single-dose vial is 0310-3040-00. 3. Drug Administration CPT Codes:
Intravenous infusion (up to 1 hour) for diagnosis, treatment, or prophylaxis (96365).
Every extra hour (list individually in addition to the code for the principal procedure) is 96366.
For instance, use 96365 for the first hour and 96366 for the second hour of a two-hour SAPHNELO infusion. 4. Diagnosis Codes: Verify that the ICD-10-CM codes on the claim support the usage of SAPHNELO and correspond to the patient's medical condition. Typical diagnoses consist of:
M32.10: Unspecified organ or system involvement in systemic lupus erythematosus.
M32.11: Systemic lupus erythematosus with endocarditis.
M32.12: Systemic lupus erythematosus and pericarditis.
M32.13: Systemic lupus erythematosus and lung involvement.
M32.14: Systemic lupus erythematosus and glomerular illness.
M32.15: Systemic lupus erythematosus and tubulo-interstitial nephritis.
M32.19: Systemic lupus erythematosus involvement of other organs or systems.
In addition to supporting medical necessity, accurate diagnosis documentation makes reimbursement easier. 5. Adjustments:
JW: Denotes the quantity of medication that was thrown away or not given to any patients.
JZ: Denotes that no medication has been thrown away or given to a patient.
The Centers for Medicare & Medicaid Services (CMS) mandates that the JZ modifier be used to show that no units of a medicine were wasted as of July 1, 2023. The JZ modifier can be used as early as January 1, 2023, however it is not necessary until July 1, 2023.
6. Documentation Standards: Keep thorough medical records that contain the following information: a precise diagnosis and conformity to accepted standards (such as those set forth by pertinent medical groups).
Weight of the patient, if it affects dosage.
A thorough medical history, particularly if previous therapies have been used.
Accurate documentation promotes medical necessity and makes reimbursement procedures run more smoothly. 7. Additional materials: For additional in-depth information, refer to the "SAPHNELO Coding Resource," which provides reimbursement support materials, sample claim forms, and coding insights.
The AstraZeneca Access 360TM program also offers personalized assistance to link patients to affordability initiatives and expedite provider access and reimbursement procedures.
To guarantee correct billing, it's critical to keep abreast of payer-specific regulations and modifications to coding standards.