## **What is the HCPCS code J9312 for?**
The HCPCS code J9312 is a J code, which means it's part of a huge cluster of HCPCS codes meant to designate medication, many of which are injected. For J9312, what is being injected is a 10 mg dosage of rituximab.
Rituximab is a monoclonal antibody that is used to treat certain cancers and autoimmune disorders, including the following:
- Diffuse large B-cell lymphoma
- Systemic lupus erythematosus
- Non-Hodgkin's lymphoma
- Chronic lymphocytic leukemia
- Granulomatosis with polyangiitis and microscopic polyangiitis
- Polyarteritis nodosa
- Rheumatoid arthritis
- Pemphigus vulgaris
- Burkitt lymphoma
- Rapidly progressive nephritic syndrome (used alongside other medicines)
- Primary central nervous system lymphoma (used to support high-dose methotrexate)
This injection is administered intravenously. Its purpose is to control a patient's disease progression by reducing symptoms, which can lead to improvements in their overall quality of life.
## **Documentation requirements for J9312**
As with any HCPCS code, J9312 requires sufficient documentation before you even decide to file a claim for it. Here are examples of what you need:
- The patient's full name
- The full names and credentials of the professionals handling the patient
- Relevant information from the patient's medical history, especially diagnoses, to support medical necessity
- Treatment regimen (dose, cycle, frequency)
- Exact dosage and route of administration
- Evidence of baseline and ongoing monitoring
- Prior treatment history
- Imaging tests, especially showing tumor locations and sizes (if any)
- Blood test results
## **Billing requirements for J9312**
Besides the documentation requirements above, please make sure to take note of or have the following:
- Drug details (dose administered, lot number, NDC code, manufacturer, etc.)
- 1 unit = 10 mg
- Bill infusion services separately using CPT codes for IV infusion
- Use appropriate ICD codes for the condition being treated
- Use either of two modifiers: JW if there's unused medication in a vial (wastage), or JZ if there's no unused medication
- Prior authorization
Please read any relevant CMS/Medicare/related coding guidelines and related policy articles to ensure you follow proper coding procedures and have complete requirements so you can avoid claim rejections.
## **Other similar and related codes**
- **J9311** - Injection, rituximab 10 mg and hyaluronidase
- **J9313** - Injection, moxetumomab pasudotox-tdfk, 0.01 mg
- **J9314** - Injection, pemetrexed (teva), not therapeutically equivalent to j9305, 10 mg
- **J9316** - Injection, pertuzumab, trastuzumab, and hyaluronidase-zzxf, per 10 mg
- **J9317** - Injection, sacituzumab govitecan-hziy, 2.5 mg
### **Related CPT codes you can use**
- CPT code 96413, if this is used for chemotherapy
- CPT code 96415, for each additional hour of infusion (accompanies 96413, if applicable)
### **Sample ICD codes**
- **C83.30** - Diffuse large B-cell lymphoma, unspecified site
- **M30.1** - Polyarteritis with lung involvement [Churg-Strauss]
- **M30.8** - Other conditions related to polyarteritis nodosa
- **D89.89** - Other specified disorders involving the immune mechanism, not elsewhere classified
- **C85.80** - Other specified types of non-Hodgkin lymphoma, unspecified site
- **I68.2** - Cerebral arteritis in other diseases classified elsewhere
- **C82.90** - Follicular lymphoma, unspecified, unspecified site
- **C91.10** - Chronic lymphocytic leukemia of B-cell type not having achieved remission
- **M05.79** - Rheumatoid arthritis with rheumatoid factor of multiple sites without organ or systems involvement
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