Medical billing and healthcare are very detail oriented. The right codes make sure patients are getting the correct bills, and making sure patient records are properly filed. Especially HCPCS codes In this guide, you’ll get a better understanding of two HCPCS codes, J1756 and J2916, used in iron replacement therapies related to Venofer® and Ferrlecit®.
Iron Replacement Products: A Lifesaver for Anemic Patients
Iron being an integral part of haemoglobin is crucial to RBCs function and tissues oxygenation, any shortages are likely to provoke an anaemic condition known as iron deficiency anaemia (IDA), which prevalence in adult and paediatric patient remains high, especially in CKD patients undergoing haemodialysis.
J1756 - Venofer® (Iron Sucrose)
J1756 represents the Venofer® injection. I receive 1 mg of iron in each bag.
FDA Approved Indications: Indicated for the treatment of patients with IDA, including patients with CKD on dialysis and adult patients and paediatric patients with CKD on dialysis receiving supplemental red blood cell (RBC) therapy.
J2916 - Ferrlecit® (Sodium Ferric Gluconate Complex in Sucrose Injection)
J2916 refers to the administration of mesulung (Sodium Ferric Gluconate Complex in Sucrose Injection). There is one vial per every injection and there are two injections given, making this a total of 25 mg of ferric iron, the soluble form. The brand name is Ferrlecit®.
FDA Approved Indications : In addition to the above, Ferrlecit® is indicated for the treatment of IDA in adult patients and paediatric patients (6 years of age and older) with CKD on hemodialysis and receiving supplemental epoetin therapy.
Why Intravenous (IV) Iron Products Shine
This implies that IV infusion of iron products are, in fact, more efficient in controlling iron deficiency in hemodialysis patients than oral iron supplements, which has to be absorbed through the GI tract before its utilisation. Usually, oral iron are poorly absorbed by the blood and some even remain unused after entering the body. This increases the chance of gastrointestinal side effects from oral iron supplements.
Expanding Coverage: Beyond Dialysis
IV iron is usually covered under Medicare to manage iron deficiency anaemia. Here is the bigger picture:
- For patients with malabsorption disorders or intolerance to oral iron supplementation.
For anemia related to chronic kidney disease.
For initial management of absolute iron deficiency in patients with chemotherapy-associated anaemia.
For pregnant beneficiaries with depleted iron stores, and when oral iron is not tolerated or when severe intra/post-partum haemorrhage is a worry.
Medicare's Ironclad Guidelines
Medicare covers Sodium Ferric Gluconate Complex in Sucrose Injection, J2916, and Iron Sucrose Injection, J1756, by name for treatment of Iron Deficiency Anemia in patients undergoing chronic hemodialysis who are receiving supplemental erythropoietintherapy, as well as to patients with documented malabsorption disorder, intolerance to oral iron supplementation, and a wide range of clinical conditions secondary to the anaemia.
Aetna's Perspective on Intravenous Iron Therapy
Aetna notes that intravenous iron ‘may be considered medically necessary’ in various situations, when patients can’t tolerate oral iron or have a rapid loss of iron, or they have disorders of the gastrointestinal tract, to name a few. It’s also a treatment of choice for chemotherapy-induced anaemia, for heart failure with iron deficiency, and more.
Dosing Considerations
Iron Dextran multi-dose preparations, as well as iron sucrose preparations (e.g. Venofer, NYSA), typically come in 50 mg vials, but single-dose vials of iron dextran (Dexferrum, Acchemax’s Infed) are also available in 100 mg preparations.
The lower the molecular weight (ie, each dextran molecule is smaller), the lower the side effects associated (eg, LMW iron dextran preparations have lower side effect rates than other preparations).
Sodium Ferric Gluconate Complex (Ferrlecit) is available in 62.5 mg Single-Dose Ampules/Vials.
Ferric gluconate complex is approved for a single dose of 125 mg, and cumulative dosing is adjusted according to patient need.
Intravenous Iron Therapy in Pregnancy
Maternal anaemia, especially iron-deficiency anaemia, in pregnancy is associated with increased maternal and perinatal morbidity and mortality. Oral iron therapy is still considered standard, especially early in pregnancy. This approach has the issue that it gets very non-adherent because of the gastrointestinal side effects. Intravenous iron may be saved as an option for the third trimester. It seems that products such as Ferrlecit can increase haemoglobin and tolerability well.
Expanding Horizons: Off-Label Uses
Besides Medicare, Medicaid and NCHS (National Coverage Determination) provide coverage for Sodium Ferric Gluconate Complex in Sucrose for off-label indications including iron deficiency anaemia from a variety of medical conditions, such as malignancy and cancer, heart failure and gastrointestinal blood loss.
Conclusion
Paying attention to coding and to the nuances of HCPCS codes J1756 and J2916, as well as learning about the latest guidelines and therapeutic options, is of the utmost importance not just for physicians who provide patient care, but also for billing personnel, healthcare providers, as well as for anyone and everyone interested in patient-centred healthcare and the effective management of care. We hope that the information shared within this article will serve as a valuable resource in the multifaceted world of iron replacement therapy moving forward.