Above all it is important to know the ground rules for IG therapy in PIDD both generally and in relation to the specific insurer. Particular payers often consider particular diagnosis codes to be supportive of the need for IG and other codes not. If you use the wrong code, there will be an immediate denial.
Most noteworthy is some payers are using preferred drug lists (PDLs) limiting the options with regard to brand. You must know the payer’s PDL as well. Usually, this information is available on the payer website or from the payer-provider rep, but sometimes the payer keeps it a secret, requiring the physician to make their best guess. Don’t guess, PBA and Associates has the information and the updates to assist your practice. We know the payer and the details.
As a result of your findings, you should start the letter by saying what you want. For example: “I am writing to request authorization for immunoglobulin supplementation therapy for the above-referenced patient with a disorder of antibody production. I have recommended intravenous immunoglobulin therapy for this patient.”
Less is more! Keep the IG approval letter to one side of a page and use the same description of the patient’s history, for example: “This patient had a long history of recurrent bacterial respiratory tract infections. An immunologic evaluation demonstrated a disorder of antibody production (laboratory studies attached).
The specific diagnosis is listed below. Because his infections could not be controlled with the most aggressive conventional therapy, this patient needs immunoglobulin supplementation therapy.”
List the ICD-10 code and its description, the specific product name with its J code followed by the dose in grams and the infusion mode and interval.
