LCD Reference Article Billing and Coding Article

Billing and Coding: Guidance for Anti-Inhibitor Coagulant Complex (AICC) National Coverage Determination (NCD) 110.3

A56065

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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.
NOT AN LCD REFERENCE ARTICLE
This article is not in direct support of an LCD.

Document Note

Note History

Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A56065
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Guidance for Anti-Inhibitor Coagulant Complex (AICC) National Coverage Determination (NCD) 110.3
Article Type
Billing and Coding
Original Effective Date
08/20/2018
Revision Effective Date
11/24/2022
Revision Ending Date
N/A
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2023 American Dental Association. All rights reserved.

Copyright © 2023, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816.

Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

Title XVIII of the Social Security Act, §1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

Article Guidance

Article Text

xx000

Response To Comments

Number Comment Response
1
N/A

Coding Information

Bill Type Codes

Code Description
N/A

Revenue Codes

Code Description
N/A

CPT/HCPCS Codes

Group 1

(4 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
Code Description
J7175 INJECTION, FACTOR X, (HUMAN), 1 I.U.
J7180 INJECTION, FACTOR XIII (ANTIHEMOPHILIC FACTOR, HUMAN), 1 I.U.
J7181 INJECTION, FACTOR XIII A-SUBUNIT, (RECOMBINANT), PER IU
J7212 FACTOR VIIA (ANTIHEMOPHILIC FACTOR, RECOMBINANT)-JNCW (SEVENFACT), 1 MICROGRAM

Group 2

(4 Codes)
Group 2 Paragraph

N/A

Group 2 Codes
Code Description
J7179 INJECTION, VON WILLEBRAND FACTOR (RECOMBINANT), (VONVENDI), 1 I.U. VWF:RCO
J7183 INJECTION, VON WILLEBRAND FACTOR COMPLEX (HUMAN), WILATE, 1 I.U. VWF:RCO
J7186 INJECTION, ANTIHEMOPHILIC FACTOR VIII/VON WILLEBRAND FACTOR COMPLEX (HUMAN), PER FACTOR VIII I.U.
J7187 INJECTION, VON WILLEBRAND FACTOR COMPLEX (HUMATE-P), PER IU VWF:RCO

Group 3

(3 Codes)
Group 3 Paragraph

N/A

Group 3 Codes
Code Description
J7188 INJECTION, FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT), (OBIZUR), PER I.U.
J7189 FACTOR VIIA (ANTIHEMOPHILIC FACTOR, RECOMBINANT), (NOVOSEVEN RT), 1 MICROGRAM
J7191 FACTOR VIII (ANTIHEMOPHILIC FACTOR (PORCINE)), PER I.U.

Group 4

(11 Codes)
Group 4 Paragraph

N/A

Group 4 Codes
Code Description
J7182 INJECTION, FACTOR VIII, (ANTIHEMOPHILIC FACTOR, RECOMBINANT), (NOVOEIGHT), PER IU
J7185 INJECTION, FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) (XYNTHA), PER I.U.
J7190 FACTOR VIII (ANTIHEMOPHILIC FACTOR, HUMAN) PER I.U.
J7192 FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U., NOT OTHERWISE SPECIFIED
J7204 INJECTION, FACTOR VIII, ANTIHEMOPHILIC FACTOR (RECOMBINANT), (ESPEROCT), GLYCOPEGYLATED-EXEI, PER IU
J7205 INJECTION, FACTOR VIII FC FUSION PROTEIN (RECOMBINANT), PER IU
J7207 INJECTION, FACTOR VIII, (ANTIHEMOPHILIC FACTOR, RECOMBINANT), PEGYLATED, 1 I.U.
J7208 INJECTION, FACTOR VIII, (ANTIHEMOPHILIC FACTOR, RECOMBINANT), PEGYLATED-AUCL, (JIVI), 1 I.U.
J7209 INJECTION, FACTOR VIII, (ANTIHEMOPHILIC FACTOR, RECOMBINANT), (NUWIQ), 1 I.U.
J7210 INJECTION, FACTOR VIII, (ANTIHEMOPHILIC FACTOR, RECOMBINANT), (AFSTYLA), 1 I.U.
J7211 INJECTION, FACTOR VIII, (ANTIHEMOPHILIC FACTOR, RECOMBINANT), (KOVALTRY), 1 I.U.

Group 5

(7 Codes)
Group 5 Paragraph

N/A

Group 5 Codes
Code Description
J7193 FACTOR IX (ANTIHEMOPHILIC FACTOR, PURIFIED, NON-RECOMBINANT) PER I.U.
J7194 FACTOR IX, COMPLEX, PER I.U.
J7195 INJECTION, FACTOR IX (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER IU, NOT OTHERWISE SPECIFIED
J7200 INJECTION, FACTOR IX, (ANTIHEMOPHILIC FACTOR, RECOMBINANT), RIXUBIS, PER IU
J7201 INJECTION, FACTOR IX, FC FUSION PROTEIN, (RECOMBINANT), ALPROLIX, 1 I.U.
J7202 INJECTION, FACTOR IX, ALBUMIN FUSION PROTEIN, (RECOMBINANT), IDELVION, 1 I.U.
J7203 INJECTION FACTOR IX, (ANTIHEMOPHILIC FACTOR, RECOMBINANT), GLYCOPEGYLATED, (REBINYN), 1 IU

Group 6

(2 Codes)
Group 6 Paragraph

N/A

Group 6 Codes
Code Description
J7196 INJECTION, ANTITHROMBIN RECOMBINANT, 50 I.U.
J7197 ANTITHROMBIN III (HUMAN), PER I.U.

Group 7

(3 Codes)
Group 7 Paragraph

N/A

Group 7 Codes
Code Description
J7170 INJECTION, EMICIZUMAB-KXWH, 0.5 MG
J7198 ANTI-INHIBITOR, PER I.U.
J7212 FACTOR VIIA (ANTIHEMOPHILIC FACTOR, RECOMBINANT)-JNCW (SEVENFACT), 1 MICROGRAM
N/A

CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(1 Code)
Group 1 Paragraph

N/A

Group 1 Codes
Code Description
D68.2 Hereditary deficiency of other clotting factors

Group 2

(9 Codes)
Group 2 Paragraph

 

 

Group 2 Codes
Code Description
D66 Hereditary factor VIII deficiency
D68.01 Von Willebrand disease, type 1
D68.020 Von Willebrand disease, type 2A
D68.021 Von Willebrand disease, type 2B
D68.022 Von Willebrand disease, type 2M
D68.023 Von Willebrand disease, type 2N
D68.03 Von Willebrand disease, type 3
D68.04 Acquired von Willebrand disease
D68.09 Other von Willebrand disease

Group 3

(6 Codes)
Group 3 Paragraph

N/A

Group 3 Codes
Code Description
D66 Hereditary factor VIII deficiency
D67 Hereditary factor IX deficiency
D68.2 Hereditary deficiency of other clotting factors
D68.311 Acquired hemophilia
D68.318 Other hemorrhagic disorder due to intrinsic circulating anticoagulants, antibodies, or inhibitors
D69.1 Qualitative platelet defects

Group 4

(1 Code)
Group 4 Paragraph

N/A

Group 4 Codes
Code Description
D66 Hereditary factor VIII deficiency

Group 5

(1 Code)
Group 5 Paragraph

N/A

Group 5 Codes
Code Description
D67 Hereditary factor IX deficiency

Group 6

(1 Code)
Group 6 Paragraph

N/A

Group 6 Codes
Code Description
D68.59 Other primary thrombophilia

Group 7

(2 Codes)
Group 7 Paragraph

N/A

Group 7 Codes
Code Description
D66 Hereditary factor VIII deficiency
D68.318 Other hemorrhagic disorder due to intrinsic circulating anticoagulants, antibodies, or inhibitors
N/A

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-PCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description
N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Code Description
N/A

Other Coding Information

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A N/A
N/A
Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A

Revision History Information

Revision History Date Revision History Number Revision History Explanation
11/24/2022 R10

Under CPT/HCPCS Codes Group 4: Codes added J7204. This revision is retroactive effective for dates of service on or after 1/1/22.

10/01/2022 R9

Please disregard revision 8, as revision 9 is displaying the correct placement of codes.

Under ICD-10 Codes that Support Medical Necessity Group 2: Codes D68.0 was deleted. Moved codes D68.01, D68.020, D68.021, D68.022, D68.023, D68.03, D68.04 and D68.09 from ICD-10 Codes that Support Medical Necessity Group 1: Codes to Group 2: Codes. This revision will become effective on 10/1/22.

10/01/2022 R8

Under ICD-10 Codes that are Covered Group 2: Codes deleted D68.0 and added D68.01, D68.020, D68.021, D68.022, D68.023, D68.03, D68.04 and D68.09. This revision is due to the Annual ICD-10-CM Update and will become effective on 10/1/22.

Under CMS National Coverage Policy added regulation Title XVIII of the Social Security Act, §1833(e). This revision will become effective 10/1/22.

01/01/2021 R7

Under CPT/HCPCS Codes Group 1: Codes and Group 7: Codes added J7212. Under CPT/HCPCS Codes Group 3: Codes changed descriptor for J7189. This revision is due to the Q1 2021 CPT/HCPCS Code Update and is retroactive effective for dates of service on or after 1/1/2021.

10/31/2019 R6

Under Article Title changed the title from “Billing and Coding: Billing and Coding Guidance for Anti-Inhibitor Coagulant Complex (AICC) National Coverage Determination (NCD) 110.3” to “Billing and Coding: Guidance for Anti-Inhibitor Coagulant Complex (AICC) National Coverage Determination (NCD) 110.3”.

07/01/2019 R5

Under CPT/HCPCS Codes Group 4: Codes added HCPCS code J7208. This revision is due to the Q3 2019 CPT®/HCPCS Code Update and is effective for dates of service on or after 7/1/2019.

01/01/2019 R4

Under CPT/HCPCS Codes Group 5: Codes added J7203. Under CPT/HCPCS Codes Group 7: Codes added J7170 and deleted Q9995. This revision is due to the Annual CPT®/HCPCS Code Update and becomes effective on 1/1/2019.

11/01/2018 R3

Under Covered ICD-10 Codes Group 7: Codes added D66. Emicizumab-kxwh (Q9995) was FDA approved for patients with hemophilia A without FVIII inhibitors. The addition of this ICD-10 code is retroactive to 10/04/2018.

11/01/2018 R2

Under CPT/HCPCS Codes Group 3: Codes added J7188. Under CPT/HCPCS Codes Group 4: Codes deleted J7188.

11/01/2018 R1

Under CPT/HCPCS Codes Group 3: Codes added J7191. Under CPT/HCPCS Codes Group 4: Codes deleted J7191.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
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Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
11/14/2022 11/24/2022 - N/A Currently in Effect You are here
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

  • Hemophilia