account art copy edit production studio coordination billing and … · e10.3219 moderate...

EYLEA is a registered trademark of Regeneron Pharmaceuticals, Inc.

© 2019, Regeneron Pharmaceuticals, Inc. All rights reserved. 05/2019 777 Old Saw Mill River Road, Tarrytown, NY 10591 US-LEA-13768(4)

Please see Indications and additional Important Safety Information throughout and accompanying full Prescribing Information.

EYLEA ICD-10* Billing and Coding Guidelines

The coding information discussed in this document is provided for informational purposes only, is subject to change, and should not be construed as legal advice. The codes listed herein may not apply to all patients or to all health plans; providers should exercise independent clinical judgment when selecting codes and submitting claims to accurately refl ect the services and products furnished to a specifi c patient.

SELECT IMPORTANT SAFETY INFORMATIONEYLEA® (afl ibercept) Injection is contraindicated in patients with ocular or periocular infections, active intraocular infl ammation, or known hypersensitivity to afl ibercept or to any of the excipients in EYLEA.*International Classifi cation of Diseases, 10th Revision, Clinical Modifi cation.

Have a billing or reimbursement question? Reimbursement Specialists are available Monday–Friday 9 AM–8 PM Eastern Time.

Call 1-855-EYLEA4U (1-855-395-3248), Option 4, or visit www.EYLEA.com.

INDICATIONSEYLEA® (afl ibercept) Injection 2 mg (0.05 mL) is indicated for the treatment of patients with Neovascular (Wet) Age-related Macular Degeneration (AMD), Macular Edema following Retinal Vein Occlusion (RVO), Diabetic Macular Edema (DME), and Diabetic Retinopathy (DR).

IMPORTANT SAFETY INFORMATION• EYLEA® (aflibercept) Injection is contraindicated in patients with ocular or periocular

infections, active intraocular inflammation, or known hypersensitivity to aflibercept or to any of the excipients in EYLEA.

• Intravitreal injections, including those with EYLEA, have been associated with endophthalmitis and retinal detachments. Proper aseptic injection technique must always be used when administering EYLEA. Patients should be instructed to report any symptoms suggestive of endophthalmitis or retinal detachment without delay and should be managed appropriately. Intraocular inflammation has been reported with the use of EYLEA.

• Acute increases in intraocular pressure have been seen within 60 minutes of intravitreal injection, including with EYLEA. Sustained increases in intraocular pressure have also been reported after repeated intravitreal dosing with VEGF inhibitors. Intraocular pressure and the perfusion of the optic nerve head should be monitored and managed appropriately.

• There is a potential risk of arterial thromboembolic events (ATEs) following intravitreal use of VEGF inhibitors, including EYLEA. ATEs are defined as nonfatal stroke, nonfatal myocardial infarction, or vascular death (including deaths of unknown cause). The incidence of reported thromboembolic events in wet AMD studies during the first year was 1.8% (32 out of 1824) in the combined group of patients treated with EYLEA compared with 1.5% (9 out of 595) in patients treated with ranibizumab; through 96 weeks, the incidence was 3.3% (60 out of 1824) in the EYLEA group compared with 3.2% (19 out of 595) in the ranibizumab group. The incidence in the DME studies from baseline to week 52 was 3.3% (19 out of 578) in the combined group of patients treated with EYLEA compared with 2.8% (8 out of 287) in the control group; from baseline to week 100, the incidence was 6.4% (37 out of 578) in the combined group of patients treated with EYLEA compared with 4.2% (12 out of 287) in the control group. There were no reported thromboembolic events in the patients treated with EYLEA in the first six months of the RVO studies.

• Serious adverse reactions related to the injection procedure have occurred in <0.1% of intravitreal injections with EYLEA including endophthalmitis and retinal detachment.

• The most common adverse reactions (≥5%) reported in patients receiving EYLEA were conjunctival hemorrhage, eye pain, cataract, vitreous detachment, vitreous floaters, and intraocular pressure increased.

Diabetic Macular Edema (DME)

Type 1 diabetes mellitus with...Right eyeLeft eyeBilateralUnspecified eye

Mild nonproliferative diabetic retinopathy with macular edemaE10.3211E10.3212E10.3213E10.3219

Moderate nonproliferative diabetic retinopathy with macular edemaE10.3311E10.3312E10.3313E10.3319

Severe nonproliferative diabetic retinopathy with macular edemaE10.3411E10.3412E10.3413E10.3419

Proliferative diabetic retinopathy with macular edemaE10.3511E10.3512E10.3513E10.3519

Unspecified diabetic retinopathy with macular edemaE10.311







Other specified diabetes mellitus with...Right eyeLeft eyeBilateralUnspecified eye






Diabetic Retinopathy (DR)

Diabetes mellitus due to underlying condition with...Right eyeLeft eyeBilateralUnspecified eye

Mild nonproliferative diabetic retinopathy without macular edemaE08.3291E08.3292E08.3293E08.3299

Moderate nonproliferative diabetic retinopathy without macular edemaE08.3391E08.3392E08.3393E08.3399

Severe nonproliferative diabetic retinopathy without macular edemaE08.3491E08.3492E08.3493E08.3499

Proliferative diabetic retinopathy without macular edemaE08.3591E08.3592E08.3593E08.3599

Unspecified diabetic retinopathy without macular edemaE08.319

Drug Administration/CPT* Codes

Intravitreal injection of a pharmacologic agent (separate procedure): LT indicates left eye injection 67028-LT

Intravitreal injection of a pharmacologic agent (separate procedure): RT indicates right eye injection 67028-RT

Intravitreal injection of a pharmacologic agent (separate procedure): 50 indicates bilateral injection 67028-50

Drug Codes for EYLEA

Injection, afl ibercept, 1 mg. With the 1 -mg descriptor, it is appropriate to indicate “2” billing units for each 2-mg injection on the claim form

HCPCS†

J0178

One single-use, sterile, 3-mL, glass vial designed to deliver 0.05 mL of 40 mg/mL EYLEA NDC‡

61755-005-02

* CPT codes, descriptions, and material are © 2011 American Medical Association. All rights reserved.

†Healthcare Common Procedure Coding System. ‡National Drug Code.

SELECT IMPORTANT SAFETY INFORMATIONAcute increases in intraocular pressure have been seen within 60 minutes of intravitreal injection, including with EYLEA. Sustained increases in intraocular pressure have also been reported after repeated intravitreal dosing with VEGF inhibitors. Intraocular pressure and the perfusion of the optic nerve head should be monitored and managed appropriately.

Please see accompanying full Prescribing Information.

Round #:

M8Printed at Size:

100%Page Size: 8.5 x 11

Bleed Size: Trim Size: Live Size:

Web/Multimedia Print CMYK Spot Colors Printer Notes

Pivot Job #: REGEMC206

Client Job #: US-LEA-13768(4)

Client: Regeneron

Account Art Copy Edit Production Studio Coordination

Product: EYLEA4U Job Name: BILLING AND CODING FLASHCARD

















































HCPCS†

J0178


61755-005-02





Round #:

M8Printed at Size:

100%Page Size: 8.5 x 11





Client: Regeneron




Drug or chemical induced diabetes mellitus with...Right eye Left eye Bilateral Unspecified eye

Mild nonproliferative diabetic retinopathy without macular edema E09.3291 E09.3292 E09.3293 E09.3299

Moderate nonproliferative diabetic retinopathy without macular edema E09.3391 E09.3392 E09.3393 E09.3399

Severe nonproliferative diabetic retinopathy without macular edema E09.3491 E09.3492 E09.3493 E09.3499

Proliferative diabetic retinopathy without macular edema E09.3591 E09.3592 E09.3593 E09.3599

Unspecified diabetic retinopathy without macular edema E09.319

Type 1 diabetes mellitus with...Right eye Left eye Bilateral Unspecified eye












Other specified diabetes mellitus with...Right eye Left eye Bilateral Unspecified eye







SELECT IMPORTANT SAFETY INFORMATIONIntravitreal injections, including those with EYLEA, have been associated with endophthalmitis and retinal detachments. Proper aseptic injection technique must always be used when administering EYLEA. Patients should be instructed to report any symptoms suggestive of endophthalmitis or retinal detachment without delay and should be managed appropriately. Intraocular inflammation has been reported with the use of EYLEA.

Wet Age-related Macular Degeneration (Wet AMD)

Exudative age-related macular degenerationRight eye Left eye Bilateral Unspecified eye

With active choroidal neovascularization H35.3211 H35.3221 H35.3231 H35.3291

With inactive choroidal neovascularization H35.3212 H35.3222 H35.3232 H35.3292

With inactive scar H35.3213 H35.3223 H35.3233 H35.3293

Stage unspecified H35.3210 H35.3220 H35.3230 H35.3290

Macular Edema following Retinal Vein Occlusion (MEfRVO)

Central retinal vein occlusionRight eye Left eye Bilateral Unspecified eye

With macular edema H34.8110 H34.8120 H34.8130 H34.8190

Tributary (branch) retinal vein occlusionRight eye Left eye Bilateral Unspecified eye



Diabetes mellitus due to underlying condition with...Right eye Left eye Bilateral Unspecified eye

Mild nonproliferative diabetic retinopathy with macular edema E08.3211 E08.3212 E08.3213 E08.3219

Moderate nonproliferative diabetic retinopathy with macular edema E08.3311 E08.3312 E08.3313 E08.3319

Severe nonproliferative diabetic retinopathy with macular edema E08.3411 E08.3412 E08.3413 E08.3419

Proliferative diabetic retinopathy with macular edema E08.3511 E08.3512 E08.3513 E08.3519

Unspecified diabetic retinopathy with macular edema E08.311





































































































Intravitreal injection of a pharmacologic agent (separate procedure): LT indicates left eye injection67028-LT

Intravitreal injection of a pharmacologic agent (separate procedure): RT indicates right eye injection67028-RT

Intravitreal injection of a pharmacologic agent (separate procedure): 50 indicates bilateral injection67028-50



HCPCS†

J0178

One single-use, sterile, 3-mL, glass vial designed to deliver 0.05 mL of 40 mg/mL EYLEANDC‡

61755-005-02





Round #:

M8Printed at Size:

100%Page Size: 8.5 x 11





Client: Regeneron


Product: EYLEA4UJob Name: BILLING AND CODING FLASHCARD




































































































HCPCS†

J0178


61755-005-02





Round #:

M8Printed at Size:

100%Page Size: 8.5 x 11





Client: Regeneron



account art copy edit production studio coordination billing and … · e10.3219 moderate...

Documents