Question 1

What is HCPCS code J7209?

Accepted Answer

HCPCS code J7209 is "Factor viii nuwiq recomb 1iu". Injection, factor viii, (antihemophilic factor, recombinant), (nuwiq), 1 i.u.

Question 2

What category is J7209 in?

Accepted Answer

J7209 belongs to HCPCS Category J (Drugs Administered Other Than Oral).

Question 3

When should I use HCPCS code J7209?

Accepted Answer

Use J7209 when billing for factor viii nuwiq recomb 1iu. 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 J7209?

Accepted Answer

Common ICD-10 diagnosis codes used with J7209 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 J7209 covered by Medicare?

Accepted Answer

Coverage for J7209 (Factor viii nuwiq recomb 1iu) 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 J7209?

Accepted Answer

Documentation for J7209 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).