Keep key information at hand about payment and coding information in the inpatient and outpatient hospital settings.
30283B1
Transfusion of Nonautologous 4-Factor Prothrombin Complex Concentrate into Vein, Percutaneous Approach
Reimbursement
Reimbursement and coding support
Hospital inpatient setting
Under the Medicare hospital inpatient prospective payment system, each inpatient stay is assigned to a single Medicare severity diagnosis-related group (MS-DRG)18
Hospital outpatient and freestanding settings of care
Effective July 1, 2021, the Centers for Medicare and Medicaid Services (CMS) has established a permanent, product-specific HCPCS code for KCENTRA19
Use the following specific ICD-10-PCS code when administrating KCENTRA
For services on or after July 1, 2021, use the permanent J-code when administrating KCENTRA
J7168
Prothrombin complex concentrate (human), KCENTRA, per IU of Factor IX activity
Summary of coding for KCENTRA*
| Code type | Procedure Code | HCPCS Code | Revenue Code | Diagnosis Code(s) |
|---|---|---|---|---|
| Hospital inpatient setting | ICD-10-PCS 30283B1 | None | eg, 025X (for KCENTRA) | Appropriate ICD-10-CM Diagnosis Code(s) |
| Hospital outpatient and freestanding settings of care | Appropriate CPT code for KCENTRA admin procedure | J7168 (KCENTRA, per IU) | eg, 0636 (with J7168) + revenue code for admin CPT | Appropriate ICD-10-CM Diagnosis Code(s) |
| Code type | Hospital inpatient setting | Hospital outpatient and freestanding settings of care |
|---|---|---|
| Procedure Code | ICD-10-PCS 30283B1 | Appropriate CPT code for KCENTRA admin procedure |
| HCPCS Code | None | J7168 (KCENTRA, per IU) |
| Revenue Code | eg, 025X (for KCENTRA) | eg, 0636 (with J7168) + revenue code for admin CPT |
| Diagnosis Code(s) | Appropriate ICD-10-CM Diagnosis Code(s) | Appropriate ICD-10-CM Diagnosis Code(s) |
*The codes being provided are from a complex and evolving medical coding system. The treating physician is solely responsible for diagnosis coding and determination of the appropriate ICD-10-CM codes that describe the patient’s condition and are supported by the medical record. All codes provided are for informational purposes and are not an exhaustive list. The CPT®, HCPCS, ICD-10-CM, and ICD-10-PCS codes provided are based on AMA or CMS guidelines. The billing party is solely responsible for coding of services (eg, CPT coding). Because government and other third-party payer coding requirements change periodically, please verify current coding requirements directly with the payer being billed.
Download the KCENTRA Reimbursement Quick Reference Card
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