Relevant Codes for CRESEMBA® (isavuconazonium sulfate)

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 CRESEMBAa:

Formulation NDC Code Code Description
Oral 0469-0520-14 Capsules packaged in aluminum blister packs, 7 per sheet
IV 0469-0420-99 Individually packaged vials for intravenous administration
Code Code Description
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
B46.0 Pulmonary mucormycosis
B46.1 Rhinocerebral mucormycosis
B46.2 Gastrointestinal mucormycosis
B46.3 Cutaneous mucormycosis
B46.4 Disseminated mucormycosis
B46.5 Mucormycosis, unspecified
B46.8 Other zygomycoses
B46.9 Zygomycosis, unspecified
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 in the HOPD setting. Confirm requirements with local payer policies.
0260 Intravenous therapy, general
0636 Drugs requiring detailed coding
Formulation NDC Code ICD-10 Code Description
Oral 0469-0520-14 N/A Capsules, 7 per sheet in aluminum blister packs
IV 0469-0420-99 XW03341 Introduction of Isavuconazole Anti-infective into Peripheral Vein, Percutaneous Approach, New Technology Group 1
XW04341 Introduction of Isavuconazole Anti-infective into Central Vein, Percutaneous Approach, New Technology Group 1
Code Code Description Notes
J1833 Injection, isavuconazonium, 1 mg Effective January 1, 2016, J1833 is used for IV formulations of CRESEMBA for billing purposes.

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 and providers submitting a claim should contact third-party payers for specific information on their coding, coverage, and payment policies. Information and materials provided by CRESEMBA Support Solutions are to assist pharmacies and other providers submitting a claim, but the responsibility to determine coverage, reimbursement, and appropriate coding for a particular patient and/or procedure remains at all times with the pharmacy and provider that submits the claim. Information provided by CRESEMBA 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.

c Section X New Technology was a section added to ICD-10-PCS beginning October 1, 2015. The new section provides a place for codes that uniquely identify procedures requested via the New Technology Application Process or that capture other new technologies not currently classified in ICD-10-PCS. The new section is simply a separate place for certain new technology procedures, such as infusion of new technology drugs. Section X does not introduce any new coding concepts or unusual guidelines for correct coding. In fact, Section X codes maintain continuity with the other sections in ICD-10-PCS by using the same root operation and body part values as their closest counterparts in other sections of ICD-10-PCS. Section X codes are standalone codes. They are not supplemental codes. Section X codes fully represent the specific procedure described in the code title, and do not require any additional codes from other sections of ICD-10-PCS. When section X contains a code title which describes a specific new technology procedure, only that X code is reported for the procedure. There is no need to report a broader, nonspecific code in another section of ICD-10-PCS. Only the IV formulation of CRESEMBA was granted an ICD-10 code.6

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. 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.

4. 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.

5. Centers for Medicare & Medicaid Services. January 2016 Update of the Hospital Outpatient Prospective Payment System (OPPS). www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9486.pdf. Accessed 10-06-2016.

6. Centers for Medicare & Medicaid Services. Using the ICD-10-PCS New Technology Section X Codes. www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1519.pdf. Accessed 10-06-2016.