D68.04 — Acquired von Willebrand disease
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Policy content not provided; unable to determine required documentation, prior authorization, or forms for AICC claims—manual review of the full policy required.
- Clinical records must clearly document the diagnosis, specific foot findings, and the clinical rationale that treatment was medically necessary and that withholding care would be hazardous to the beneficiary.
- For the policy’s asterisked/complicating conditions, include the name of the primary physician (MD or DO) who made the diagnosis and the approximate date of the last visit; this information must be included in the medical record and entered on the appropriate claim forms or electronic equivalent when billing Medicare.
- Follow CMS website instructions for billing Part A and Part B claims and Noridian guidance for JE Part B claims; include required claim form entries/electronic equivalents.
Key Coverage Criteria
- Policy content not provided; unable to determine covered indications for AICC NCD 110.3—manual review of the full policy required.
- Routine foot care is covered only when clinical documentation demonstrates the patient’s condition warrants the provider to render the services and that failure to provide the services would be hazardous to the beneficiary due to underlying medical condition(s), per CMS Pub 100-02, Ch.15, §290.
- Off-label IVIG use may be billed when supported by the applicable Local Coverage Determination (LCD) and by documentation of medical necessity; off-label is defined as not in Medicare-approved compendia or the FDA label.
- IVIG may be used in bone marrow/stem cell transplantation when the recipient was CMV seropositive before transplantation, or after allogeneic transplantation for hematologic neoplasm when both donor and recipient were CMV seronegative.
- IVIG may be used in solid organ transplantation when the donor was CMV seropositive and the recipient was CMV seronegative prior to transplantation.
- IVIG may be used for recurrent severe infections when there is documented severe or absent IgG subclass deficiency or clinically significant functional humoral immunity deficiency (failure to produce specific antibodies) with a history of recurrent infections.
8 Active Policies
L40181 — Off-Label Use of Intravenous Immune Globulin (IVIG)
J06
A59105 — Billing and Coding: Off-Label Use of Intravenous Immune Globulin (IVIG)
J06
A60187 — Billing and Coding: Off-Label Use of Intravenous Immune Globulin (IVIG)
J06
L39314 — Off-Label Use of Intravenous Immune Globulin (IVIG)
J06
Related Codes
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