Coding Rhogan Passive Anti-D Antibodies

Arna Safar

Best answers
Would you code Rhogan passive anti-D antibodies in a pregnant woman as 656.10 or would you use some other combination such as 795.79 followed by V72.86?


Best answers
Can you please provide little more info?
Was the encounter for prophylactic injection of the Rho D antibodies?
If so,
I very much doubt about giving 795.79 because main category795 states about ABNORMAL findings. I feel that the "passive" does not come under this abnormal finding.
V72.9 is for blood group typing which is done already in this case before and the patient now recieves(d) anti D injection at this encounter.

{A brief note about the disease: The disease can be prevented by treating the mother during pregnancy or promptly (within 72 hours) after childbirth. The mother would receive an intramuscular injection of anti-Rh antibodies (Rho (D) Immune Globulin) so that the fetal Rhesus D positive erythrocytes are destroyed before her immune system can discover them. This is passive immunity and the effect of the immunity will wear off after about 4 to 6 weeks (or longer depending on injected dose) as the anti-Rh antibodies gradually decline to zero in the maternal blood.
This reduces the effect of the vast majority of sensitizing events which mostly occur after 28 weeks gestation. It is a part of modern antenatal care to give all Rhesus D negative pregnant women an anti-RhD IgG immunoglobulin injection at about 28 weeks gestation (with or without a booster at 34 weeks gestation).

About ICD-9 code, 656.10 would appropriate better, as per the Reimbersement guidelines.

656.10 is recommended- Pl see below:
Reimbursement Guidelines
RhoGAM® Ultra-Filtered PLUS/ MICRhoGAM® Ultra-Filtered PLUS
(Last Revised: July 2007)

This document is intended to provide general information about product, procedure and other codes used for RhoGAM® Brand and MICRhoGAM® Brand.

Codes Used in Physicians' Offices, Clinics and Outpatient Departments
Product Codes
Product Code Use
Rho(D) immune globulin (Rhlg), human, full-dose, for intramuscular use 90384 CPT® Private payers and some state
Medicaid programs1
J27902 Medicare and some state Medicaid1
Rho(D) immune globulin (Rhlg), human, mini-dose, for intramuscular use 90385 CPT® Private payers and some state
Medicaid programs1
J27883 Medicare and some state Medicaid programs1
Current Procedural Terminology (CPT®) five-digit codes, descriptions, and other data only are copyright 2005 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT®

Procedure Codes
Service Code Use
Therapeutic, prophylactic or diagnostic injection (specify substance or drug); subcutaneous
or intramuscular 96372 CPT® Medicare (hospital outpatient
claims), state Medicaid programs
and private payers

Inpatient Codes

ICD-9-CM Diagnosis Codes4
656 Other fetal and placental problems affecting management of mother
656.1X Rhesus isoimmunization
Anti-D [Rh] antibodies
RH incompatibility 5th Digit required: 0-Unspecified as to the episode of care or not applicable
1-Delivered, with or without mention of antepartum condition
3-Antepartum condition or complication
999.7 Rh incompatibility reaction

ICD-9-CM Procedure Codes
99.11 Injection of Rh immune globulin

Medicare Revenue Codes

The charge for the Rho D immune globuline drug should be listed on the HCFA-1450 (UB-92) under revenue code 0250 (General Classification Pharmacy) or 063X (Pharmacy-Drugs Requiring Detailed Coding) as required by the payer.
National Drug Codes (NDC)
HCPCS Code (J2790, 90384) NDC 0562-7805-01
NDC 0562-7805-05 RhoGAM® Single Pack
RhoGAM® 5 Pack
NDC 0562-7805-25 RhoGAM® 25 Pack
HCPCS Code (J2788, 90385) NDC 0562-7806-01
NDC 0562-7806-05 MICRhoGAM® Single Pack
MICRhoGAM® 5 Pack
NDC 0562-7806-25 MICRhoGAM® 25 Pack
NOTE The coding information in this document is derived from the CPT, ICD-9-CM and Healthcare Common Procedure Coding System (HCPCS) level II codebooks. The general rules and principles about using these coding sources, as described in this publication, will likely remain constant for years to come. However the actual numeric and alphanumeric codes themselves are subject to change with each subsequent annual revision of these sourcebooks. That is why it is important to have a new copy of this book and every coding book referenced each and every year.
DISCLAIMER The information contained in this document is provided for informational purposes only and represents no statement, promise, or guarantee by Ortho-Clinical Diagnostics concerning levels of reimbursement, payment, or charges. Similarly, all CPT (Copyright AMA) and HCPCS codes are supplied for informational purposes only and represent no statement, promise, or guarantee by Ortho-Clinical Diagnostics that these codes will be appropriate or that reimbursement will be made. It is not intended to increase or maximize reimbursement by any payer. We strongly recommend that you consult your payer organization with regard to its reimbursement policies.
1 Always confirm coding requirements with payer prior to claims submission

2 Official descriptor for J2790-Injection, Rho(D) Immune globulin, human full dose, 300 mcg

3 Official descriptor for J2788-Injection, Rho(D) Immune globulin, human, minidose, 50 mcg

4 International Classification of Diseases, Ninth Revision, Clinical Modifications (ICD-9-CM)

Thank you.