Prescribing CINRYZE

Jeanie, a real HAE patient, helps prevent her attacks with CINRYZE

Reimbursement for CINRYZE

Summary of codes1-3
Diagnosis Code ICD-10-CM
D84.1
Description
Defects in the complement system (C1 esterase inhibitor [C1-INH] deficiency)
Biologic Code HCPCS
J0598
Description
Injection, C1 esterase inhibitor (human), 10 units
NDC
42227 081 05
Description
C1 esterase inhibitor (human)
Administration CPT
96374
Description
Therapeutic, prophylactic or diagnostic injection (specify substance or drug), IV push, single or initial substance/drug
96375 Therapeutic, prophylactic or diagnostic injection (specify substance or drug), each additional sequential IV push (add-on code only)
E/M Service or Office Visit CPT
99211*
Description
E/M of an established patient may not require the presence of a physician
99212 E/M of an established patient, which requires 2 of 3 key components:
  • A problem-focused history
  • A problem-focused examination
  • Straightforward medical decision making
99213 E/M of an established patient, which requires 2 of 3 key components:
  • An expanded problem-focused history
  • An expanded problem-focused examination
  • Medical decision making of low complexity
99214 E/M of an established patient, which requires 2 of 3 key components:
  • A detailed history
  • A detailed examination
  • Medical decision making of a moderate complexity
99215 E/M of an established patient, which requires 2 of 3 key components:
  • A comprehensive history
  • A comprehensive examination
  • Medical decision making of high complexity

Shire is providing this reimbursement information for informational purposes only. Reimbursement information is subject to change, and each payer may have different coding requirements for claim submissions. Healthcare professionals are responsible for the accuracy of their claims and related reimbursement documentation and must ensure that all reimbursement submissions comply with current rules and regulations. Shire suggests that you confirm all coding with payers before filing claims. Shire does not guarantee coverage or payment for its products.

*Please note that CMS will not allow CPT code 99211 to be billed on the same date of service as a drug administration code.

For a printable version of this coding card, download the PDF here.

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References

  1. Hart AC, Stegman MS, eds. International Classification of Diseases, 9th Revision, Clinical Modification, 2009 Expert for Hospitals. 6th ed. Salt Lake City, UT: Ingenix; 2008.
  2. Healthcare Common Procedure Coding System Level II, 2009 Expert. Salt Lake City, UT: Ingenix; 2008.
  3. Current Procedural Terminology 2009, Professional Edition. Chicago, IL: American Medical Association; 2008.

Definition: