Question 1

What is HCPCS code J7189?

Accepted Answer

HCPCS code J7189 is "Factor viia recomb novoseven". Factor viia (antihemophilic factor, recombinant), (novoseven rt), 1 microgram

Question 2

What category is J7189 in?

Accepted Answer

J7189 belongs to HCPCS Category J (Drugs Administered Other Than Oral).

Question 3

When should I use HCPCS code J7189?

Accepted Answer

Use J7189 when billing for factor viia recomb novoseven. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

What ICD-10 codes are commonly used with J7189?

Accepted Answer

Common ICD-10 diagnosis codes used with J7189 include: D66 (Hereditary factor VIII deficiency), D67 (Hereditary factor IX deficiency), D68.01 (Von Willebrand disease, type 1), D68.020 (Von Willebrand disease, type 2A). Always ensure proper medical documentation supports the medical necessity for the HCPCS code being billed.

Question 5

Is J7189 covered by Medicare?

Accepted Answer

Coverage for J7189 (Factor viia recomb novoseven) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 6

What documentation is required for J7189?

Accepted Answer

Documentation for J7189 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).