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New Hemophilia Diagnosis Codes for Add-On Payment

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Monday, February 6, 2012

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The diagnosis codes required to receive payment for blood clotting factors provided to hemophilia inpatients were changed effective October 1, 2011 with the new ICD-9-CM code updates.

ICD-9-CM diagnosis codes 286.52 (acquired hemophilia), 286.53 (Antiphospholipid antibody with hemorrhagic disorder), and 286.59 (Other hemorrhagic disorder due to intrinsic circulating anticoagulants, antibodies, or inhibitors) replace 286.5 effective October 1, 2011.

Note that the add-on payment criteria will not be updated until April 2, 2012. If you use the new codes on claims prior to April 2012, you will not receive the add-on reimbursement. There will be no automatic adjustment of affected claims. Providers must notify the MAC to have the affected claims adjusted after the implementation.

For more information, see MLN Matters Article MM7553 

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This material was compiled to share information.  MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful.