Health Information Management

Consider the following guidance and tips when billing IVIG

APCs Insider, April 27, 2007

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Question: Should we code and charge intravenous immunoglobulin (IVIG) as a chemotherapy drug as we do for RemicadeĀ®, or should we code and charge it as an IV infusion? Is there a compiled list of biologicals that we should code and bill as chemotherapy?

Answer: IVIG has been shown to be an effective treatment for a variety of autoimmune, infectious, and idiopathic diseases. Review your FI's local coverage determination (LCD) to identify appropriate and specific diagnoses for this covered service, if applicable. Different IVIG preparations are manufactured in the U.S., including Gammagard S/D, Gammar-IV, Gamimune-N, Iveegam, Gamunex, and SandoglobulinĀ®. Review the manufacturers' Web sites to help assign proper HCPCS codes for this drug.

Use the following HCPCS codes to report this detailed drug. Pay specific attention to the long descriptor and dosage to properly report correct units to your FI:

  • J1562: Injection, immune globulin, subcutaneous, 100 mg
  • J1565: Injection, respiratory syncytial virus immune globulin, intravenous, 50 mg
  • J1566: Injection, immune globulin, intravenous, lyophilized (e.g., powder), 500 mg
  • J1567: Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), 500 mg

When staff administer IVIG as a plasma protein replacement therapy for immune deficient patients to bolster their decreased or abolished antibody production capabilities, report the following codes as appropriate:

  • 90765: Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour; and
  • 90766: Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure). 

It is imperative that clinical documentation supports the total number of hour(s) of IVIG administration you bill. In other words, the documentation should contain the time that staff started and completed the IVIG treatment. Note that starting January 1 of this year, CMS reimburses for all additional hours of hydration, therapeutic, and chemotherapy infusion.

We recommend that you contact your FI for a complied list of biologicals or monoclonal antibodies, as CMS has not released such a list. Look to your pharmacy and oncology departments for additional assistance with classification. 

Final tip: CMS continues to separately reimburse HCPCS code G0332 (Preadministration-related services for intravenous infusion of immunoglobulin, per infusion encounter) in 2007. You can report G0332 in addition to the administration codes listed above each time the patient presents for this service. According to the April 2007 OPPS Addendum B, G0332 maps to APC 1502, paying $75 nationally.

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