Relevant Billing Codes for AmBisome® (amphotericin B) liposome for injection
Properly coding claims can help facilitate timely claims processing and reduce the risk of denied claims. Coding requirements vary by payer.1 The coding systems in the following tables can assist you in proper coding for AmBisomea:
National Drug Code (NDC)2
Universal 11-digit product identifier for human drugs; each NDC identifies the labeler, product, and trade package size
| Code | Code Description | Notes |
|---|---|---|
| 00469-3051-30 | 50-mg single-use vial (amphotericin B) liposome | Individual vial carton |
ICD-10-CM Diagnosis Codes3
Numeric classification descriptive of diseases, injuries, and causes of death, used in hospital outpatient and physician office settings
| Code | Code Description |
|---|---|
| B20 | Human immunodeficiency virus (HIV) disease |
| B37.0 | Candidal stomatitis |
| B37.1 | Pulmonary candidiasis |
| B37.41 | Candidal cystitis and urethritis |
| B37.5 | Candidal meningitis |
| B37.6 | Candidal endocarditis |
| B37.7 | Candidal sepsis |
| B37.81 | Candidal esophagitis |
| B37.82 | Candidal enteritis |
| B37.89 | Other sites of candidiasis |
| B37.9 | Candidiasis, unspecified |
| B44.0 | Invasive pulmonary aspergillosis |
| B44.1 | Other pulmonary aspergillosis |
| B44.2 | Tonsillar aspergillosis |
| B44.7 | Disseminated aspergillosis |
| B44.81 | Allergic bronchopulmonary aspergillosis |
| B44.89 | Other forms of aspergillosis |
| B44.9 | Aspergillosis, unspecified |
| B45.0 | Pulmonary cryptococcosis |
| B45.1 | Cerebral cryptococcosis |
| B45.2 | Cutaneous cryptococcosis |
| B45.3 | Osseous cryptococcosis |
| B45.7 | Disseminated cryptococcosis |
| B45.8 | Other forms of cryptococcosis |
| B45.9 | Cryptococcosis, unspecified |
| B55.0 | Visceral leishmaniasis |
| B97.35 | HIV 2 as the cause of diseases classified elsewhere |
| D70.0 | Congenital agranulocytosis |
| D70.1 | Agranulocytosis secondary to cancer chemotherapy |
| D70.2 | Other drug-induced agranulocytosis |
| D70.3 | Neutropenia due to infection |
| D70.4 | Cyclic neutropenia |
| D70.8 | Other neutropenia |
| D70.9 | Neutropenia, unspecified |
| G02 | Meningitis in other infectious and parasitic diseases classified elsewhere |
| G03.0 | Nonpyogenic meningitis |
| G03.1 | Chronic meningitis |
| G03.8 | Meningitis due to other specified causes |
| G03.9 | Meningitis, unspecified |
| H44.19 | Other endophthalmitis |
| I30.0 | Acute nonspecific idiopathic pericarditis |
| I30.1 | Infective pericarditis |
| I30.8 | Other forms of acute pericarditis |
| I30.9 | Acute pericarditis, unspecified |
| I32 | Pericarditis in diseases classified elsewhere |
| I33.0 | Acute and subacute infective endocarditis |
| I33.9 | Acute and subacute endocarditis, unspecified |
| I38 | Endocarditis, valve unspecified |
| I39 | Endocarditis and heart valve disorders in diseases classified elsewhere |
| I40.0 | Infective myocarditis |
| I40.8 | Other acute myocarditis |
| I40.9 | Acute myocarditis, unspecified |
| I41 | Myocarditis in diseases classified elsewhere |
| R50.81 | Fever presenting with conditions classified elsewhere |
| R50.82 | Postprocedural fever |
| R50.9 | Fever, unspecified |
| R68.0 | Hypothermia, not associated with low environmental temperature |
| R68.83 | Chills (without fever) |
| R75 | Inconclusive laboratory evidence of human immunodeficiency virus [HIV] |
| Z21 | Asymptomatic human immunodeficiency virus [HIV] infection status |
ICD-10-PCS Procedure Codes4
Numeric classification descriptive of procedures performed in hospital inpatient setting
| Code | Code Description | Notes |
|---|---|---|
| 3E03029 | Introduction of Other Anti-infective into Peripheral Vein, Open Approach | Assign the appropriate code for the service provided |
| 3E03329 | Introduction of Other Anti-infective into Peripheral Vein, Percutaneous Approach | |
| 3E04029 | Introduction of Other Anti-infective into Central Vein, Open Approach | |
| 3E04329 | Introduction of Other Anti-infective into Central Vein, Percutaneous Approach |
Revenue Codes5
4-digit codes that all hospitals use to capture cost data by department
| Code | Code Description | Notes |
|---|---|---|
| 0250 | Pharmacy-General | Some payers, such as Medicare, require certain combinations of revenue codes and Healthcare Common Procedure Coding System (HCPCS) or CPT®b codes to facilitate claims processing. Confirm requirements with local payer policies |
| 0260 | IV Therapy-General | |
| 0636 | Drugs Requiring Specific ID |
CPT Codes6,b
5-digit codes that describe procedures and services performed by physicians and other healthcare providers
| Code | Code Description | Notes |
|---|---|---|
| 96365 | Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour | Select appropriate codes based on length of infusion |
| 96366 | Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (list separately in addition to code for primary procedure) |
a IMPORTANT INFORMATION: The coding, coverage, and payment information contained herein is gathered from various resources, general in nature, and subject to change without notice. Third-party payment for medical products and services is affected by numerous factors. It is always the provider's responsibility to determine the appropriate healthcare setting and to submit true and correct claims conforming to the requirements of the relevant payer for those products and services rendered. Pharmacies (or any other provider submitting a claim) should contact third-party payers for specific information on their coding, coverage, and payment policies. Information and materials provided by AmBisome Support Solutions are to assist providers and pharmacies, but the responsibility to determine coverage, reimbursement, and appropriate coding for a particular patient and/or procedure remains at all times with the provider and pharmacy, and information provided by AmBisome Support Solutions or Astellas should in no way be considered a guarantee of coverage or reimbursement for any product or service.
b American Medical Association. Current Procedural Terminology (CPT). Professional edition, 2023. All rights reserved. Applicable FARS/DFARS Restrictions Apply to Government Use. 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.
References
1. Beck DE, Margolin DA. Physician coding and reimbursement. Ochsner J 2007;7:8-15.
2. AmBisome [package insert]. Northbrook, IL: Astellas Pharma US, Inc.
3. Centers for Disease Control and Prevention. ICD-10-CM tabular list of diseases and injuries 2023. https://www.cms.gov/medicare/icd-10/2023-icd-10-cm. Accessed 07-19-2023.
4. ICD10Data.com. The web's free 2023 ICD-10/PCS medical coding reference. https://www.icd10data.com. Accessed 07-19-2023.
5. Centers for Medicare & Medicaid Services. CMS manual system. www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/r167cp.pdf. Accessed 07-19-2023.
6. American Medical Association. CPT® 2023 Professional Edition. Chicago, IL: American Medical Association, 2022.
AmBisome® is a registered trademark of Gilead Sciences, Inc.