Relevant Codes for AmBisome® (amphotericin B) liposome for injection

Properly coding claims will 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 will assist you in proper coding for AmBisomea:

Code Code Description Notes
00469-3051-30 50-mg single-use vial (amphotericin B) liposome Packs of 10 individual vial cartons
Code Code Description Notes
B20 Human immunodeficiency virus (HIV) disease Assign the appropriate diagnosis code based on medical record documentation
B37.1 Pulmonary candidiasis
B37.7 Candidal sepsis
B37.81 Candidal esophagitis
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
B44.89 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 Human immunodeficiency virus, type 2 (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
I40.1 Isolated 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
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
Code Code Description Notes
0250 Pharmacy-General Some payers, such as Medicare, require certain combinations of revenue codes and HCPCS or CPTb codes to facilitate claims processing. Confirm requirements with local payer policies
0260 IV Therapy-General
0636 Drugs Requiring Specific ID
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 Current Procedural Terminology (CPT), Professional Edition, 2016. American Medical Association, 2015. All rights reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no responsibility for the data contained herein. CPT is a registered trademark of the American Medical Association.

References

1. Beck DE, Margolin DA. Physician coding requirement. Ochsner J. 2007;7:8-15.

2. Centers for Medicare & Medicaid Services. 2017 ICD-10-CM and GEMs. www.cms.gov/Medicare/Coding/ICD10/2017-ICD-10-CM-and-GEMs.html. Accessed 12-07-2016.

3. Centers for Medicare & Medicaid Services. 2017 ICD-10-PCS and GEMS. www.cms.gov/Medicare/Coding/ICD10/2017-ICD-10-PCS-and-GEMs.html. Accessed 12-07-2016.

4. Centers for Medicare & Medicaid Services. CMS manual system. www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS018912.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=ascending. Accessed 12-06-2016.

AmBisome® is a registered trademark of Gilead Sciences, Inc.