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Oncology & Hematology Coding Alert

READER QUESTIONS:

Check Payers' IVIG Preference

Published on Thu May 12, 2005

Question: I've heard that we aren't supposed to report immune globulin with J1563 anymore. Would you explain how to code this now?


Pennsylvania Subscriber
Answer: The answer depends on which payer you're dealing with. Some payers still accept the J codes, but starting April 1, 2005, many are asking for Q codes. You need to ask your payer to determine which codes it accepts.

If your payer switched to the Q codes, you should report the following instead of J1563 (Injection, immune globulin, intravenous, 1 g) or J1564 (...10 mg):
  Q9941 IVIG lyophilized 1 gram  $56.36
  Q9942    IVIG lyophilized 10 mg  $0.56 
  Q9943    IVIG non-lyophilized 1 gram $39.14
  Q9944    IVIG non-lyophilized 10 mg $0.39

Caution: The early pricing lists switched the reimbursements, suggesting the non-lyophilized garnered higher reimbursement. In fact, you should expect higher reimbursement for lyophilized.
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