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HCPCS Code J3358: Ustekinumab, for Intravenous Injection, 1 mg
## **What is the HCPCS code J3358 for?**
The HCPCS code J3358 is a J code, which means it's part of a massive group of HCPCS codes that are mostly meant to designate injected medication. For J3358, what is being injected is a 1 mg dose of ustekinumab.
Ustekinumab is a type of monoclonal antibody. This medicine targets certain proteins in the immune system, specifically interleukin-12 (IL-12) and interleukin-23 (IL-23), both of which are involved in inflammatory and immune responses. It inhibits these proteins, and doing so allows the medication to modulate the immune system in a way that makes it effective in reducing inflammation and fighting against autoimmune conditions and their symptoms, such as moderate to severe plaque psoriasis, active psoriatic arthritis, ulcerative colitis, and Crohn's disease.
During the induction phase of the treatment, ustekinumab is injected intravenously. Subsequent encounters for maintenance therapy involve subcutaneous injections of ustekinumab.
## **Documentation requirements for J3358**
For injected medication such as ustekinumab, please ensure that you have the following documentation:
- The full name of the personnel who administered the injection, + their credentials
- The name and address of the facility where the injection was administered
- The NDC code of the injection
- The full name of the patient
- The date and time of the drug administration by injection, including start and stop times
- Patient records showing they have been diagnosed with related conditions that this injection treats (e.g., psoriasis, psoriatic arthritis, Crohn's disease, ulcerative colitis)
- Blood test results that provide information on liver function and overall health
- Infection screening results, especially for tuberculosis
- Patient's treatment plan
- Monitoring and follow-up dates and findings
- The exact dosage
## **Billing requirements for J3358**
Besides the documentation requirements above, please note the following billing requirements for this HCPCS code:
- They must reflect the dosage given over the course of the treatment. In this case, 1 mg = 1 unit
- The appropriate ICD code(s) for the patient's condition
- Use either of two modifiers: JW if there's unused medication in a vial (wastage), or JZ if there's no unused medication.
- The CPT code 96365, since this is an intravenous injection
Make sure you follow the coding guidelines set by the CMS so you can avoid claim rejections.
It became effective January 1, 2018, and it's still valid now.
All injected medication will result in pain and discomfort in the injection site. Other common but minor side effects include feeling fatigued and having headaches. Rare complications include being at risk of tuberculosis and other infections, anaphylaxis, and possible worsening of existing conditions the patient has. It's best to observe the patient for at least an hour after the intravenous infusion.
It varies from person to person. Some will notice the benefits in just a few weeks, while some may take a few months.
