[CIS PIDD] [cis-pidd] medicare IVIG question

[James L. Friedlander, M.D.]

Thanks. While I can’t be sure, I do know that they did not have any issues with recurrent infections prior to the lymphoma diagnosis, and all are 65+ in age. 

JLF

On Nov 26, 2013, at 3:11 PM, Richard Wasserman <drrichwasserman at gmail.com> wrote:


> CVID patients are at risk for lymphoma. Do you know that they didn't have CVID before they were treated? If their Ig levels support CVID, I'd use 279.06.

> Richard Wasserman

> Dallas

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> On Tue, Nov 26, 2013 at 2:57 PM, James L. Friedlander, M.D. <jfriedlander at allergyasthmaimm.com> wrote:

> I have several Medicare patients with B cell lymphoma treated with rituximab that develop recurrent sinopulmonary infections during/after treatment, along with significant hypogammaglobulinemia and non-protective antibody titers.  Medicare is requiring one of the diagnoses listed below before they will approve treatment with immune replacement.  

> 

> 279.04 Congenital hypogammaglobulinemia

> 279.05 Immunodeficiency with increased IgM

> 279.06 CVID

> 279.12 WAS

> 279.2 Combined ID

> 

> I would argue that none of these are correct, as these patients clearly have drug-induced immunodeficiency.  Listing hypogammaglobulinemia alone or in combination with antibody deficiency for diagnosis codes does not work for Medicare, but this has worked for some private insurance companies.  

> 

> Anyone else come across this issue?  Thanks.

> 

> Jim Friedlander

> Omaha, NE

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> Richard L. Wasserman, MD, PhD

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