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Injectafer coverage access tabs
Billing and Coding
| Code | Description | |
|---|---|---|
| Product package code | ||
| NDC | 0517-0602-01 | Injectafer (ferric carboxymaltose injection) 100 mg iron/2 mL single-use vial (individually boxed) |
| NDC | 00517-0650-01 | Injectafer (ferric carboxymaltose injection) 750 mg iron/15 mL single-use vial (individually boxed) |
| Product-specific billing code | ||
| HCPCS | J1439 | Injection, ferric carboxymaltose, 1 mg |
| Drug administration codes | ||
| CPT®* | 96374 or 96365 |
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug) Intravenous push single or initial substance drug Intravenous infusion for therapy, prophylaxis, or diagnosis (specify substance or drug); initial up to 1 hr |
CPT, Current Procedural Terminology; FARS/DFARS, Federal Acquisition Regulation/Defense Federal Acquisition Regulation Supplement; HCPCS, Healthcare Common Procedure Coding System; NDC, National Drug Code.
We recommend verifying the coding policies for each individual health plan. Access Central Coordinators can provide information relating to payer-specific policies and can address other questions at 1-866-4-DSI-NOW.
Examples of ID/IDA-related diagnosis codes
Injectafer claims forms require an appropriate ICD-10-CM code. The following table displays possible ICD-10-CM codes related to ID/IDA.*
| CODE | DESCRIPTION |
| D50.0 | Iron deficiency anemia secondary to blood loss (chronic) |
| D50.1 | Sideropenic dysphagia |
| D50.8 | Other iron deficiency anemias |
| D50.9 | Iron deficiency anemia, unspecified |
| E61.1 | Iron deficiency (excludes iron deficiency anemia) |
| D63.0 | Anemia in neoplastic disease CODE NEOPLASM FIRST (Confirm iron deficiency) |
| D63.1 | Anemia in chronic kidney disease CODE CKD STAGE FIRST (Confirm iron deficiency) |
| D63.8 | Anemia in other chronic diseases classified elsewhere CODE UNDERLYING DISEASE FIRST (Confirm iron deficiency) |
| D63.81 | Antineoplastic chemotherapy-induced anemia (Confirm iron deficiency) |
Other codes may be appropriate.
Coding for Injectafer is dependent on the insurer and the care setting in which the drug will be administered. These tables are provided for informational purposes only, and you have the responsibility to ensure that claims and codes submitted are accurate, complete, and applicable. Healthcare providers need to make coding decisions based on the diagnosis and treatment of each patient and the specific insurer. Please visit CMS.gov or other payers’ websites to obtain additional guidance on their processes.
A code specific for your IDA patient’s underlying condition†
The following table displays possible ICD-10-CM codes that may be appropriate for patients prescribed Injectafer.*
| CODE | DESCRIPTION |
| K50.0-K50.919 | Crohn's disease [regional enteritis] |
| K51.0-K51.919 | Ulcerative colitis |
| K90.0 | Celiac disease |
| K90.4 | Malabsorption due to intolerance not elsewhere classified |
| K90.9 | Intestinal malabsorption unspecified |
| N18.1 | Chronic kidney disease, stage 1 |
| N18.2 | Chronic kidney disease, stage 2 |
| N18.30 | Chronic kidney disease stage 3 unspecified |
| N18.31 | Chronic kidney disease stage 3a |
| N18.32 | Chronic kidney disease stage 3b |
| N18.4 | Chronic kidney disease, stage 4 |
| N18.5 | Chronic kidney disease, stage 5 |
| N18.6 | End-stage renal disease |
| N18.9 | Chronic kidney disease, unspecified |
| N92.0 | Excessive and frequent menstruation with regular cycle |
| N92.5 | Other specified irregular menstruation |
| N92.6 | Irregular menstruation, unspecified |
| T45.4X5A | Adverse effect of iron and its compounds, initial encounter |
| T50.905A | Adverse effect of unspecified drugs, medicaments and biological substances, initial encounter |
A code for your patient with ID in HF†
The following table displays possible ICD-10-CM codes that may be appropriate for patients prescribed Injectafer.*
| CODE | DESCRIPTION |
| I09.81 | Rheumatic heart failure |
| I11.0 | Hypertensive heart disease with heart failure |
| I50 | Heart failure |
| I50.1 | Left ventricular failure, unspecified |
| I50.2 | Systolic (congestive) heart failure |
| I50.20 | Unspecified systolic (congestive) heart failure |
| I50.21 | Acute systolic (congestive) heart failure |
| I50.22 | Chronic systolic (congestive) heart failure |
| I50.23 | Acute on chronic systolic (congestive) heart failure |
| I50.3 | Diastolic (congestive) heart failure |
| I50.30 | Unspecified diastolic (congestive) heart failure |
| I50.31 | Acute diastolic (congestive) heart failure |
| I50.32 | Chronic diastolic (congestive) heart failure |
| I50.33 | Acute on chronic diastolic (congestive) heart failure |
| I50.4 | Combined systolic and diastolic (congestive) heart failure |
| I50.40 | Unspecified combined systolic and diastolic (congestive) heart failure |
| I50.41 | Acute combined systolic and diastolic (congestive) heart failure |
| I50.42 | Chronic combined systolic and diastolic heart failure |
| I50.43 | Acute on chronic combined systolic and diastolic heart failure |
| I50.8 | Other heart failure |
| I50.81 | Right heart failure |
| I50.810 | Right heart failure, unspecified |
| I50.811 | Acute right heart failure |
| I50.812 | Chronic right heart failure |
| I50.813 | Acute on chronic right heart failure |
| I50.814 | Right heart failure due to left heart failure |
| I50.82 | Biventricular heart failure |
| I50.83 | High output heart failure |
| I50.84 | End stage heart failure |
| I50.89 | Other heart failure |
| I50.9 | Heart failure, unspecified |
*A joint effort between the healthcare provider and the coder is essential to achieve complete and accurate documentation, code assignment, and reporting of diagnoses and procedures. This information is provided to assist both the healthcare provider and the coder in identifying potential diagnoses. The importance of consistent, complete documentation in the medical record cannot be overemphasized. Without such documentation, accurate coding cannot be achieved. The entire record should be reviewed to determine the specific reason for the encounter and the conditions treated.
†Secondary code suggestions only; appropriate codes not limited to those listed above. Injectafer is indicated to treat ID in adult patients with HF and NYHA II/III; it is not indicated to treat the above-listed underlying conditions. Some listed diagnosis codes may indicate a subcategory and be nonbillable. For reporting purposes, only codes with the full number of required characters are permissible.
HF, heart failure; ICD-10-CM, International Classification of Diseases, Tenth Revision, Clinical Modification; ID, iron deficiency; IDA, iron deficiency anemia; NYHA, New York Heart Association.
We recommend verifying the coding policies for each individual health plan. Reimbursement specialists can provide information relating to payer-specific policies and can address other questions at 1-866-4-DSI-NOW.
The completion and submission of coverage- or reimbursement-related documentation are the responsibility of the patient and healthcare provider. Daiichi Sankyo, Inc., makes no representation or guarantee concerning coverage or reimbursement for any service or item. A completed form includes signatures from both the physician and the patient. Before submitting, please ensure all required information is provided.