FallingApart Posted July 31, 2009 Report Share Posted July 31, 2009 Hello again, I can't tell you how much I appreciate your replies to my earlier post. Because of you all, we are so close to getting the IVIG scheduled for tomorrow. In fact, it is scheduled right now. There is one last aspect that I would like to see if I can work on prior to it and that is insurance. Our ped talked with the hospital that is going to administer it and it will be $10k. I know this is not news to any of you. But for those of you who have used the autoimmune encephalitis diagnosis, do you know what the code is? Our ped is also looking for it, but she also has her job to do so I thought I would see if anyone here might know this code. Thank you so much for all your help. You are a great group of parents! Link to comment Share on other sites More sharing options...
mom md Posted July 31, 2009 Report Share Posted July 31, 2009 I don't have a coding book right now but 279.4 is autoimmune disease not otherwise specified. Encephalitis is 323.8 and 323.9. Hope this helps and good luck. Link to comment Share on other sites More sharing options...
Guest asaxon Posted July 31, 2009 Report Share Posted July 31, 2009 Hello again, I can't tell you how much I appreciate your replies to my earlier post. Because of you all, we are so close to getting the IVIG scheduled for tomorrow. In fact, it is scheduled right now. There is one last aspect that I would like to see if I can work on prior to it and that is insurance. Our ped talked with the hospital that is going to administer it and it will be $10k. I know this is not news to any of you. But for those of you who have used the autoimmune encephalitis diagnosis, do you know what the code is? Our ped is also looking for it, but she also has her job to do so I thought I would see if anyone here might know this code. Thank you so much for all your help. You are a great group of parents! I know nothing about medical billing, but I found this online list of codes--http://www.cms.hhs.gov/ICD9ProviderDiagnosticCodes/ "279.4 Autoimmune disease, not elsewhere classified / Autoimmune disease NOS / Excludes: transplant failure or rejection" Under "HEREDITARY AND DEGENERATIVE DISEASES OF THE CENTRAL NERVOUS SYSTEM (330-337)": 333 Other extrapyramidal disease and abnormal movement disorders / Includes: other forms of extrapyramidal, basal ganglia, or striatopallidal disease" Incidentally, I stumbled across this Aetna policy document that explicitly excludes IVIG coverage for PANDAS: http://www.aetna.com/cpb/medical/data/200_299/0206.html Link to comment Share on other sites More sharing options...
ShaesMom Posted July 31, 2009 Report Share Posted July 31, 2009 I sent you a PM on this with some codes. Link to comment Share on other sites More sharing options...
FallingApart Posted July 31, 2009 Author Report Share Posted July 31, 2009 Thanks so much everyone for your responses and PMs. Our Ped tried the ins co last night but they were closed. She will be calling them again any time this morning and is likely going to be using 279.9 or 279.4. That is what she said last night when I last spoke with her. I will update this post with what she actually decided on and the results. She is taking the orders to our hospital this morning at 9 am and we are taking our daughter at noon. We will stay overnight and hopefully come home tomorrow. I am scared to death but incredibly hopeful. Again, thank you so much for your help! You all are the ones who helped make this happen for us! Link to comment Share on other sites More sharing options...
ShaesMom Posted July 31, 2009 Report Share Posted July 31, 2009 I'm so glad you didn't give up and kept pushing. Remember, pump her full of fluids! She will be fine!! I'll be thinking about you today and tomorrow. WAY TO GO GIRL!!!!!!!! Link to comment Share on other sites More sharing options...
Worried_Dad Posted August 1, 2009 Report Share Posted August 1, 2009 We have had 3 rounds of IVIG done with Dr. K in Chicago. When we were working to get pre-approval from our insurance co, Dr. K's secretary provided diagnosis and procedure codes. The diagnosis code Dr. K uses for these PANDAS cases is 279.30. I've been told since that this indicates some kind of generalized immune deficiency? Anyway, our insurance (BCBS) did approve the IVIG for this diagnosis code, so it seemed to work. (Of course, the Oakbrook Surgical Center in Chicago was "non-participating," so we had to pay up-front, and it still took us 8 months to get any reimbursement... argh!). Good luck!!! Link to comment Share on other sites More sharing options...
FallingApart Posted August 16, 2009 Author Report Share Posted August 16, 2009 Hello everyone, Below are the codes that our ped used: IVIG 90283 Infusion 96365 I believe these are the hospital codes. THe CD#9 codes - which I believe are insurance codes were 279.4 and 323.41 Link to comment Share on other sites More sharing options...
Buster Posted August 16, 2009 Report Share Posted August 16, 2009 I think our dr. used: 279.9 -- Unspecified disorder of immune mechanism and 348.30 -- Encephalopathy unspecified but not positive -- haven't seen bill yet. Hello everyone, Below are the codes that our ped used: IVIG 90283 Infusion 96365 I believe these are the hospital codes. THe CD#9 codes - which I believe are insurance codes were 279.4 and 323.41 Link to comment Share on other sites More sharing options...
pixiesmommy Posted September 4, 2009 Report Share Posted September 4, 2009 Dr K uses 348.39 and 392.9 I found this link helpful to look up codes: http://icd9cm.chrisendres.com/ Link to comment Share on other sites More sharing options...
Christianmom Posted March 2, 2011 Report Share Posted March 2, 2011 I bumped up this thread because I was curious if the people who replied with diagnosis codes had to have their IVIG pre-authorized. And if the IVIG had to be pre-authorized, what was the insurance company looking for to allow it. I believe my insurance company will not approve IVIG for any diagnosis code without reauthorization and I am trying to find out what that means. What lab work, etc. did the doctor have to submit for the diagnosis codes suggested in this thread to be "pre-authorized." Or did your insurance just allow the diagnosis code to go through without pre-authorization. Link to comment Share on other sites More sharing options...
Joan Pandas Mom Posted March 3, 2011 Report Share Posted March 3, 2011 (edited) I think with Dr. B. it was 279.04 or 279.06. Good luck. Edited March 3, 2011 by Joan Pandas Mom Link to comment Share on other sites More sharing options...
butterflymom Posted March 3, 2011 Report Share Posted March 3, 2011 (edited) = Edited October 5, 2015 by tampicc Link to comment Share on other sites More sharing options...
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