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

[Harville, Terry O]

Jim,

While these on one hand may not be "technically" correct in the modern concept of CVID...if the laboratory definition of CVID includes B lymphocyte count of less than 200 cells/mcL, and IgG less than 400 mg/dL along with either IgM or IgA or both also deficient...then they could fall into the laboratory category of CVID, albeit semantic.  If pneumococcal responses can be shown to be impaired, there is further support of the laboratory diagnosis of CVID.

Taking the caveats altogether the patients then become an "acquired" CVID...but...we used to call many patients with CVID "Acquired Hypogammaglobulinemia" to distinguish from XLA.

Thus...if the laboratory criteria fit...then using Acquired Hypogammaglobulinemia 279.06 could be a correct ICD-9-CM term.

Terry Harville MD PhD
-Medical Director, Special Immunology Laboratory
-Medical Director, Histocompatibility Laboratory
-Medical Director, Immunogenetics and Transplantation Laboratory
-Specialist in Pediatric Immunology and Rheumatology
Departments of Pathology and Laboratory Services and Pediatrics
University of Arkansas for Medical Sciences
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Mail Slot #502
Little Rock, AR  72205-7199

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From: James L. Friedlander, M.D. [mailto:jfriedlander at allergyasthmaimm.com]
Sent: Tuesday, November 26, 2013 3:15 PM
To: CIS-PIDD
Subject: Re: [cis-pidd] medicare IVIG question

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<mailto: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

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