Are you submitting claims for Hemophilia/Blood Clotting Factors correctly?
Please be aware that Health Care Procedure Coding System (HCPCS) code descriptions for J7186, J7187, J7189, J7190-J7195, and J7198 are defined by drug name and dosage (per International Unit (IU) or per 1 microgram).
HCPCS Codes
J7186 Injection, antihemophilic factor VIII/ von Willebrand factor complex, (human), per factor VIII IU
J7187 Injection, von Willebrand factor complex, human, ristocetin cofactor, per IU
J7189 Factor VII (antihemophilic factor, recombinant), 1 microgram (mcg)
J7190 Factor VIII (antihemophilic factor, human), per IU
J7191 Factor VIII (antihemophilic factor, porcine), per IU
J7193 Factor IX (antihemophilic factor, purified, non-recombinant), per IU
J7194 Factor IX antihemophilic factor, complex, per IU
J7195 Factor IX antihemophilic factor, recombinant), per IU
J7198 Anti- inhibitor, per IU
J7199 Hemophilia clotting factor, not otherwise classified
In order for WPS Medicare to correctly price these codes, providers must indicate the total dosage per number of IUs or in micrograms (not the number of vials used) in item 19 of the Centers for Medicare & Medicaid Services (CMS) 1500 form, or in the narrative record if filing electronically. List the units of service as one in item 24G of the 1500 form.
When using code J7199, Hemophilia clotting factor, Not Otherwise Classified (NOC), indicate the name of the drug, the total dosage in International Units (IUs) or the number of micrograms, not number of vials), and the method of administration in item 19 of the CMS 1500 form, or in the narrative record if filing electronically. List the units of service as one in item 24G of the 1500 form. If filing electronically, the total units should be placed in the NSF Format, Record FAO-18.0, ANSI 837 format Segment SV1-05 (3032) or Segment SV1-04 (3051).
Page Last Updated: Thursday, 18-Mar-2010 05:56:14 CDT
