Relevant Billing Codes for Mycamine® (micafungin for injection)
Properly coding claims can 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 can assist in proper coding for Mycaminea:
National Drug Codes (NDC)
Universal 11-digit product identifier for human drugs; each NDC identifies the labeler, product, and trade package size
|00469-3250-10||50-mg single-use vial||Carton of 10 individually packaged 50-mg single-use vials|
|00469-3211-10||100-mg single-use vial||Carton of 10 individually packaged 100-mg single-use vials|
ICD-10-CM Diagnosis Codes2
Numeric classification descriptive of diseases, injuries, and causes of death, used in hospital outpatient and physician office setting
|B37.89||Other sites of candidiasis|
|Z48.290||Encounter for aftercare following bone marrow transplant|
|Z94.81||Bone marrow transplant status|
|Z94.84||Stem cells transplant 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|
|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 CPT®b codes to facilitate claims processing. Confirm requirements with local payer policies|
|0636||Drugs requiring detailed coding|
5-digit alphanumeric code
|J2248||Injection, micafungin sodium, 1 mg||This code represents a partial vial of micafungin sodium. Report the appropriate number of units based on amount of drug provided to the patient|
5-digit codes that describe procedures and services performed by physicians and other healthcare providers (HCPs)
|96365||Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour||Assign the appropriate code(s) for the service provided|
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. Providers should contact third-party payers for specific information on their coding, coverage, and payment policies. Information and materials provided by Mycamine Support Solutions are to assist HCPs, 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 information provided by Mycamine Support Solutions or Astellas should in no way be considered a guarantee of coverage or reimbursement for any product or service.
b American Medical Association. Current Procedural Terminology (CPT). Professional edition, 2019. All rights reserved. Applicable FARS/DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.
1. Beck DE, Margolin DA. Physician coding and reimbursement. Ochsner J. 2007;7:8-15.
2. Centers for Medicare & Medicaid Services. 2019 ICD-10-CM and GEMs. www.cms.gov/medicare/coding/icd10/2019-icd-10-cm.html. Accessed 01-31-2019.
3. Centers for Medicare & Medicaid Services. 2019 ICD-10-PCS and GEMS. www.cms.gov/Medicare/Coding/ICD10/2019-ICD-10-PCS.html. Accessed 01-31-2019.
4. Centers for Medicare & Medicaid Services. CMS manual system. www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/r167cp.pdf. Accessed 01-31-2019.
MYCAMINE® is a registered trademark of Astellas Pharma Inc.