icd-10 code for monoclonal antibody infusion

In addition to the seven new 2022 ICD-10 procedure codes announced in November, the Centers for Medicare & Medicaid Services on April 1 will implement two new ICD-10 procedure codes for reporting COVID-19 therapeutics. The new codes are for describing the infusion of tixagevimab and cilgavimab monoclonal antibody (code XW023X7), and the infusion of other new technology monoclonal antibody (code XW023Y7).

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How to code monoclonal antibody?

Jan 13, 2022 · In addition to the seven new 2022 ICD-10 procedure codes announced in November, the Centers for Medicare & Medicaid Services on April 1 will implement two new ICD-10 procedure codes for reporting COVID-19 therapeutics. The new codes are for describing the infusion of tixagevimab and cilgavimab monoclonal antibody (code XW023X7), and the …

Which monoclonal antibody is best?

Mar 03, 2022 · What ICD-10 diagnosis code should be billed for the COVID-19 vaccine or mAb infusion? Diagnosis code Z23 is the primary diagnosis required for the COVID-19 vaccine. The mAb infusion billing enter the appropriate diagnosis coded to highest level of specificity (U071 - use as appropriate).

When to administer monoclonal antibodies?

If you administer COVID-19 monoclonal antibodies to Medicare patients in traditional health care locations (for example, a hospital outpatient infusion clinic or freestanding infusion clinic), continue to bill HCPCS codes M0240, M0243, M0245, M0247, or M0222, as applicable.

How do you administer monoclonal antibodies?

Oct 01, 2021 · Z01.84 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM Z01.84 became effective on October 1, 2021. This is the American ICD-10-CM version of Z01.84 - other international versions of ICD-10 Z01.84 may differ.

What is the code for mAb infusion?

CMS developed two procedure codes, M0239 and M0243. When coverage criteria were established by CMS for these codes, no professional component was “split out” to allow both professional and institutions to billed for the same code as other outpatient procedure codes. In the situation described, the physician attending to the patient care should bill the appropriate evaluation and management code and the hospital bills for the mAb infusion.

What modifier is used for E/M?

During the PHE, we would anticipate this circumstance to be a common occurrence, and physicians and non-physician practitioners furnishing these services on the same day should add modifier “25” to the E/M code to identify it as a medically necessary E/M service furnished on the same day that another service is furnished by the same physician or other supplier. Similarly, hospital outpatient departments furnishing separately identifiable office visits on the same day a vaccine or mAb infusion is administered should also add modifier “25” to identify a medically necessary E/M service furnished on the same day as another service.

Can mAB be administered in emergency settings?

mAB may only be administered in settings in which health care providers have immediate access to medications to treat a severe infusion reaction, such as anaphylaxis, and the ability to activate the emergency medical system, as necessary. Reference: Monoclonal Antibody COVID-19 Infusion. 6.

Is DR condition code required?

The DR condition code is not required.

Is mAb on NCCI?

At this time the mAb infusions currently are not on the NCCI edit files and should not impact claims when the patient is receiving other infusions. The NCCI edit files are updated quarterly so be sure to review the current files.

What is the EUA for bamlanivimab?

On November 9, 2020, the U.S. Food and Drug Administration (FDA) issued an emergency use authorization (EUA) for the investigational monoclonal antibody therapy, bamlanivimab, for the treatment of mild-to-moderate COVID-19 in adults and pediatric patients with positive COVID-19 test results who are at high risk for progressing to severe COVID-19 and/or hospitalization. Bamlanivimab may only be administered in settings in which health care providers have immediate access to medications to treat a severe infusion reaction, such as anaphylaxis, and the ability to activate the emergency medical system (EMS), as necessary. Review the Fact Sheet for Health Care Providers EUA of Bamlanivimab regarding the limitations of authorized use.

Can you use bamlanivimab in emergency settings?

Bamlanivimab may only be administered in settings in which health care providers have immediate access to medications to treat a severe infusion reaction, such as anaphylaxis, and the ability to activate the emergency medical system (EMS), as necessary.

When will the ICd 10-CM Z01.84 be released?

The 2022 edition of ICD-10-CM Z01.84 became effective on October 1, 2021.

What is a Z00-Z99?

Categories Z00-Z99 are provided for occasions when circumstances other than a disease, injury or external cause classifiable to categories A00 -Y89 are recorded as 'diagnoses' or 'problems'. This can arise in two main ways:

Medicare reminds healthcare providers of an important coverage change through claims denials

Ever since a public health emergency (PHE) for COVID-19 was declared on Jan. 27, 2020, there has been several new HCPCS Level II codes created for monoclonal antibody (mAb) products and administration.

mAb Product and Administration Codes

Here are the most current codes for investigational monoclonal antibody therapies with emergency use authorization (EUA) and applicable administration codes:

Billing Monoclonal Antibody Therapeutics

Medicare will pay for COVID-19 mAb under the Medicare Part B vaccine benefit through the end of the calendar year that the PHE ends — so at least Dec. 31, 2022. Medicare payment is typically at reasonable cost or at 95 percent of the average sales price (ASP). See payment allowance limits for Medicare Part B drugs, effective Jan.

What is a CPT injection?

CPT® defines a therapeutic, prophylactic, or diagnostic injection (96372) as requiring “direct physician supervision” and, typically, “special consideration to prepare, dose or dispose of … practice training and competency for staff who administer infusions, and … periodic patient assessment.”.

What is CPT code 96401?

Code 96401 may be used for a variety of drugs, including: non-radionuclide anti-neoplastic drugs. anti-neoplastic agents provided for treatment of noncancer diagnoses. certain monoclonal antibody agents and other biologic response modifiers. CPT® does not specifically identify those “certain monoclonal antibody agents and other biologic response ...

Does CPT 96401 apply to monoclonal antibodies?

CPT® does not specifically identify those “certain monoclonal antibody agents and other biologic response modifiers” that would qualify under 96401.

What is the condition code for mAb infusion?

Medicare Advantage claims for the COVID-19 vaccine and mAb infusions, require the condition code (CC) 78 to be reported on the claim to avoid the claim from rejecting.

Can you report multiple units of tocilizumab?

For tocilizumab, roster billing cannot be used to report multiple units or infusions. Submit individual claims for the tocilizumab product and infusions when reporting multiple units of the product and/or the first and second infusions.

Can tocilizumab be infused in the hospital?

Under the terms of the EUA, tocilizumab may only be infused in the hospital setting (TOB 12X). CMS pays for tocilizumab based on the number of units administered, so include the total number of units administered on the claim per day. For example: