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Coding
and Billing

 

Coding and billing information for Rapivab® (peramivir injection)

Use this information to facilitate coding and billing processes. Some payers will require the National Drug Code (NDC) code for Rapivab.1

 

Support and access for Rapivab

RAPIVAB CUSTOMER SUPPORT CENTER
1-855-358-8966 and rapivab.com

 

  • Current Procedural Terminology (CPT) Codes for Rapivab

    The following CPT codes are for treatments administered via injection to individuals.

    CPT Code 2 Description
    96365 Intravenous (IV) infusion for therapy, prophylaxis, or diagnosis; initial, up to first hour
    96366 IV med therapy−each additional hour
    96374 IV med injection−first med
    96375 IV med injection−second med subsequent injection
    96376 IV med injection−first med subsequent injection
    96360 IV hydration−first hour
    96361 IV hydration−each additional hour

     

    HCPCS Code 3 Description
    J2547 Injection, peramivir, 1 mg
    • Report the administration of Rapivab in addition to the treatment product code
    • Assign the appropriate administration code based on the documentation in the medical record
    • Medicare requires the use of an HCPCS code for the administration of Rapivab. Some payers may also require that an HCPCS code be used to report Rapivab

    Prior authorizations or appeals may not be completed or filed on the HCP's behalf.

  • Revenue codes for Rapivab

    These codes are used to attribute hospital charges to specific cost centers. They may vary by service provided and patient status.

    Revenue Code 4 Description
    0636 Drugs requiring detailed coding required by Medicare to obtain pass-through payment for drugs in the outpatient department
    0250 Pharmacy, general
    0260 Intravenous therapy, general
    0450 Emergency room
    0510 Clinic
    0520 IV hydration–first hour
  • ICD-10-CM codesa for Rapivab

    Refer to these tables when you need the ICD-10-CM codes for Rapivab.

    ICD-10 Code 5 Description
    J10.00 Influenza due to other identified influenza virus with unspecified type of pneumonia
    J10.01 Influenza due to other identified influenza virus with the same other identified influenza virus pneumonia
    J10.08 Influenza due to other identified influenza virus with other specified pneumonia
    J11.00 Influenza due to unidentified influenza virus with unspecified type of pneumonia
    J11.08 Influenza due to unidentified influenza virus with specified pneumonia
    J12.9 Viral pneumonia, unspecified
    J10.1 Influenza due to other identified influenza virus with other respiratory manifestations
    J11.1 Influenza due to unidentified influenza virus with other respiratory manifestations
    J10.2 Influenza due to other identified influenza virus with gastrointestinal manifestations
    J10.81 Influenza due to other identified influenza virus with encephalopathy
    J10.82 Influenza due to other identified influenza virus with myocarditis
    J10.83 Influenza due to other identified influenza virus with otitis
    J10.89 Influenza due to other identified influenza virus with other manifestations
    J11.2 Influenza due to unidentified influenza virus with gastrointestinal manifestations
    J11.81 Influenza due to unidentified influenza virus with encephalopathy
    J11.82 Influenza due to unidentified influenza virus with myocarditis
    J11.83 Influenza due to unidentified influenza virus with otitis media
    J11.89 Influenza due to unidentified influenza virus with other manifestations
    J09.X1 Influenza due to identified novel influenza A virus with pneumonia
    J09.X2 Influenza due to identified novel influenza A virus with other respiratory manifestations
    J09.X3 Influenza due to identified novel influenza A virus with gastrointestinal manifestations
    J09.X9 Influenza due to identified novel influenza A virus with other manifestations

    aThis may not be an all-inclusive list; see payor-specific coverage policies for covered indication.

References: 1. Rapivab [package insert]. Summit, NJ: Seqirus USA Inc; 2017. 2. Procedural coding expert: the ultimate guide to CPT coding. Salt Lake City, UT: Contexo Media; 2013. 3. Parman C. Hospital regulatory update. Association of Community Cancer Centers website. https://www.accc-cancer.org/oncology_issues/articles/JF16/JF16-Oncology-Coding-Reimbursement-Update.pdf. Accessed March 11, 2016. 4. CMS Manual System: Pub. 100-04 Medicare claims processing. Centers for Medicare & Medicaid Services website. https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/r167cp.pdf. Published April 30, 2004. Accessed July 15, 2016. 5. Nelson M. ICD-10 cometh. https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=5&cad=rja&uact=8&ved=0ahUKEwih4NKzjLfLAhXLTCYKHc2LAAUQFgg5MAQ&url=https%3A%2F%2Fwww.chestnet.org%2F~%2Fmedia%2Fchesnetorg%2FPublications%2FDocuments%2FCHEST%2520Physician%2FICD10InfluenzaCodes.ashx&usg=AFQjCNH5tCT-_gZ8SmRF_CZi0vB-OvUyFQ&sig2=JQocAaPEHmQ0wQsagrgHLQ&bvm=bv.116573086,d.cWw. Published April 2015. Accessed March 10, 2016.
Important Safety Information  

Important Safety Information

Rapivab® (peramivir injection) is indicated for the treatment of acute uncomplicated influenza in patients 18 years and older who have been symptomatic for no more than 2 days.

Efficacy of Rapivab was based on clinical trials in which the predominant influenza virus type was influenza A; a limited number of subjects infected with influenza B virus were enrolled.

Influenza viruses change over time. Emergence of resistance substitutions could decrease drug effectiveness. Other factors (for example, changes in viral virulence) might also diminish clinical benefit of antiviral drugs. Prescribers should consider available information on influenza drug susceptibility patterns and treatment effects when deciding whether to use Rapivab.

Efficacy could not be established in patients with serious influenza requiring hospitalization.

Contraindications

Rapivab is contraindicated in patients with known serious hypersensitivity or anaphylaxis to peramivir or any component of the product. Severe allergic reactions have included anaphylaxis, erythema multiforme, and Stevens-Johnson syndrome.

Warnings and Precautions
  • Rare cases of serious skin reactions, including erythema multiforme, have been reported with Rapivab in clinical studies and in postmarketing experience. Cases of anaphylaxis and Stevens-Johnson syndrome have been reported in postmarketing experience with Rapivab. Discontinue Rapivab and institute appropriate treatment if anaphylaxis or a serious skin reaction occurs or is suspected. The use of Rapivab is contraindicated in patients with known serious hypersensitivity or anaphylaxis to Rapivab.

  • Patients with influenza may be at an increased risk of hallucinations, delirium, and abnormal behavior early in their illness. There have been postmarketing reports (from Japan) of delirium and abnormal behavior leading to injury in patients with influenza who were receiving neuraminidase inhibitors, including Rapivab. Because these events were reported voluntarily during clinical practice, estimates of frequency cannot be made, but they appear to be uncommon. These events were reported primarily among pediatric patients. The contribution of Rapivab to these events has not been established. Patients with influenza should be closely monitored for signs of abnormal behavior.

  • Serious bacterial infections may begin with influenza-like symptoms or may coexist with or occur as complications during the course of influenza. Rapivab has not been shown to prevent such complications.

Adverse Reactions

The most common adverse reaction was diarrhea (8% Rapivab vs 7% placebo).

Lab abnormalities (incidence ≥2%) occurring more commonly with Rapivab than placebo were elevated ALT 2.5 times the upper limit of normal (3% vs 2%), elevated serum glucose >160 mg/dL (5% vs 3%), elevated CPK at least 6 times the upper limit of normal (4% vs 2%) and neutrophils <1.0 x 109/L (8% vs 6%).

Concurrent Use With Live Attenuated Influenza Vaccine

Antiviral drugs may inhibit viral replication of a live attenuated influenza vaccine (LAIV). The concurrent use of Rapivab with LAIV intranasal has not been evaluated. Because of the potential for interference between these two products, avoid use of Rapivab within 2 weeks after or 48 hours before administration of LAIV unless medically indicated.

Please see full prescribing information for Rapivab.

You are encouraged to report negative side effects of prescription drugs to the FDA.

Visit www.fda.gov/Safety/MedWatch/ or call 1-800-FDA-1088.