Relevant Billing 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:
National Drug Code (NDC)
Universal 11-digit product identifier for human drugs; each NDC identifies the labeler, product, and trade package size
|00469-3051-30||50-mg single-use vial (amphotericin B) liposome||Packs of 10 individual vial cartons|
ICD-10-CM Diagnosis Codes2
Numeric classification descriptive of diseases, injuries, and causes of death, used in hospital outpatient and physician office settings
|B20||Human immunodeficiency virus (HIV) disease||Assign the appropriate diagnosis code based on medical record documentation|
|B37.89||Other sites of candidiasis|
|B44.0||Invasive pulmonary aspergillosis|
|B44.1||Other pulmonary aspergillosis|
|B44.89||Other forms of aspergillosis|
|B45.8||Other forms of cryptococcosis|
|B97.35||Human immunodeficiency virus, type 2 (HIV 2) as the cause of diseases classified elsewhere|
|D70.1||Agranulocytosis secondary to cancer chemotherapy|
|D70.2||Other drug-induced agranulocytosis|
|D70.3||Neutropenia due to infection|
|G02||Meningitis in other infectious and parasitic diseases classified elsewhere|
|G03.8||Meningitis due to other specified causes|
|I30.0||Acute nonspecific idiopathic 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|
|I40.8||Other acute myocarditis|
|I40.9||Acute myocarditis, unspecified|
|I41||Myocarditis in diseases classified elsewhere|
|R50.81||Fever presenting with conditions classified elsewhere|
|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 Codes3
Numeric classification descriptive of procedures performed in hospital inpatient setting
|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|
4-digit codes that all hospitals use to capture cost data by department
|0250||Pharmacy-General||Some payers, such as Medicare, require certain combinations of revenue codes and Healthcare Common Procedure Coding System (HCPCS) or CPTb codes to facilitate claims processing. Confirm requirements with local payer policies|
|0636||Drugs Requiring Specific ID|
5-digit codes that describe procedures and services performed by physicians and other healthcare providers
|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.
1. Beck DE, Margolin DA. Physician coding requirement. Ochsner J. 2007;7:8-15.
2. Centers for Medicare & Medicaid Services. 2018 ICD-10-CM and GEMs. www.cms.gov/Medicare/Coding/ICD10/2018-ICD-10-CM-and-GEMs.html. Accessed 01-31-2018.
3. Centers for Medicare & Medicaid Services. 2018 ICD-10-PCS and GEMS. www.cms.gov/Medicare/Coding/ICD10/2018-ICD-10-PCS-and-GEMs.html. Accessed 01-31-2018.
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 01-31-2018.
AmBisome® is a registered trademark of Gilead Sciences, Inc.