Billing and Coding: Immune Thrombocytopenia (ITP) Therapy

This billing and coding guidance requires valid ICD-10-CM diagnosis codes and adherence to NCCI/OPPS coding edits when submitting claims for ITP therapy. Use the appropriate ABN modifiers (-GA, -GX, -GZ, -GY) according to whether an ABN was signed and the expected reason for denial, document the ordering/referring provider and full medical record (including signed encounter notes and test results), and include occurrence code 32 and ABN date on Part A claims when -GA is used.

"A claim submitted without a valid ICD-10-CM diagnosis code will be returned to the provider as an incomplete claim under Section 1833(e) of the Social Security Act."

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