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Out with Q2044, In with J0490

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  • In Coding
  • March 2, 2012
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For the treatment of adult patients with active, autoantibody-positive systemic lupus erythematosus (SLE) who are receiving standard therapy, you would be correct to report HCPCS Level II code Q2044 Injection, belimumab, 10 mg for dates of service July 1, 2011 through Dec. 31, 2011. For 2012, however, at least one Medicare administrative contractor (MAC) has indicated a code change.
TrailBlazer Health Enterprises, Medicare administrative contractor for jurisdiction 4 (J4-MAC) issued a notice Feb. 22 indicating that, when billing Belimumab (Benlysta®) for dates of service on or after Jan. 1, 2012, you should instead report J0490 Belimumab injection, 10 mg with ICD-9-CM 710.0 Systemic lupus erythematosus.
When reporting Benlysta® for Medicare payment, the medical record must clearly demonstrate the patient has been diagnosed with SLE. Simply reporting 710.0 is inappropriate, TrailBlazer warns.
Belimumab was approved by the U.S. Food and Drug Administration (FDA) March 9, 2011 for the treatment of SLE. Its use is considered investigational for other autoimmune diseases.

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