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ICD-10 Support

ICD-10 Support

The ICD-10 Diagnosis Codes for Providers

Please refer to the current policy for the latest codes since these codes are subject to change. The codes provided are not intended to be exhaustive. Please consult your ICD-10 code book for additional information.

Third-party reimbursement is affected by many factors. This content and the information and assistance provided by Janssen CarePath are presented for informational purposes only. They do not constitute reimbursement or legal advice. Janssen CarePath does not promise or guarantee coverage, levels of reimbursement, or payment.

Similarly, all CPT®* and HCPCS codes are supplied for informational purposes only and represent no statement, promise, or guarantee, expressed or implied, by Janssen and its third-party service providers that these codes will be appropriate or that reimbursement will be made. The fact that a drug, device, procedure, or service is assigned an HCPCS code and a payment rate does not imply coverage by the Medicare program, but indicates only how the product, procedure, or service may be paid if covered by the Medicare program.

Laws, regulations, and policies concerning reimbursement are complex and are updated frequently. Accordingly, the information may not be current or comprehensive. Janssen and its third-party service providers strongly recommend you consult your payer for its most current coverage, reimbursement, and coding policies. Janssen and its third-party service providers make no representations or warranties, expressed or implied, as to the accuracy of the information provided. In no event shall the third-party service providers or Janssen, or their employees or agents, be liable for any damages resulting from or relating to any information provided by, or accessed to or through, Janssen CarePath. All HCPs and other users of this information agree that they accept responsibility for the use of this program.

*CPT® – Current Procedural Terminology. CPT® is a registered trademark of the American Medical Association, 2019.

Click below for ICD-10 CODES.

PSORIATIC ARTHRITIS

ICD-10 Indication ICD-10 Code
Psoriasis L40
Arthropathic psoriasis, unspecified L40.50
Distal interphalangeal psoriatic arthropathy L40.51
Psoriatic arthritis mutilans L40.52
Psoriatic spondylitis L40.53
Psoriatic juvenile arthropathy L40.54
Other psoriatic arthropathy L40.59

PSORIASIS, OTHER

ICD-10 Indication ICD-10 Code
Psoriasis vulgaris L40.0
Generalized pustular psoriasis L40.1
Acrodermatitis continua L40.2
Pustulosis palmaris et plantaris L40.3
Guttate psoriasis L40.4
Other psoriasis L40.8
Psoriasis, unspecified L40.9

REGIONAL ENTERITIS / CROHN'S DISEASE

ICD-10 Indication ICD-10 Code
Crohn's disease K50
Use additional code to identify manifestations
Crohn's disease of small intestine K50.0
... without complications K50.00
... with complications K50.01
... with rectal bleeding K50.011
... with intestinal obstruction K50.012
... with fistula K50.013
... with abscess K50.014
... with other complication K50.018
... with unspecified complications K50.019
Crohn's disease of large intestine K50.1
... without complications K50.10
... with complications K50.11
... with rectal bleeding K50.111
... with intestinal obstruction K50.112
... with fistula K50.113
... with abscess K50.114
... with other complication K50.118
... with unspecified complications K50.119
Crohn's disease of both small and large intestine K50.8
... without complications K50.80
... with complications K50.81
... with rectal bleeding K50.811
... with intestinal obstruction K50.812
... with fistula K50.813
... with abscess K50.814
... with other complication K50.818
... with unspecified complications K50.819
Crohn's disease, unspecified K50.9
... without complications K50.90
... with complications K50.91
... with rectal bleeding K50.911
... with intestinal obstruction K50.912
... with fistula K50.913
... with abscess K50.914
... with other complication K50.918
... with unspecified complications K50.919

ULCERATIVE COLITIS

ICD-10 Indication ICD-10 Code
Ulcerative Colitis K51
Use additional code to identify manifestations
Ulcerative (chronic) pancolitis K51.0
... without complications K51.00
... with complications K51.01
... with rectal bleeding K51.011
... with intestinal obstruction K51.012
... with fistula K51.013
... with abscess K51.014
... with other complication K51.018
... with unspecified complications K51.019
Ulcerative (chronic) proctitis K51.2
... without complications K51.20
... with complications K51.21
... with rectal bleeding K51.211
... with intestinal obstruction K51.212
... with fistula K51.213
... with abscess K51.214
... with other complication K51.218
... with unspecified complications K51.219
Ulcerative (chronic) rectosigmoiditis K51.3
... without complications K51.30
... with complications K51.31
... with rectal bleeding K51.311
... with intestinal obstruction K51.312
... with fistula K51.313
... with abscess K51.314
... with other complication K51.318
... with unspecified complications K31.319
Left sided colitis K51.5
... without complications K51.50
... with complications K51.51
... with rectal bleeding K51.511
... with intestinal obstruction K51.512
... with fistula K51.513
... with abscess K51.514
... with other complication K51.518
... with unspecified complications K51.519
Other ulcerative colitis K51.8
... without complications K51.80
... with complications K51.81
... with rectal bleeding K51.811
... with intestinal obstruction K51.812
... with fistula K51.813
... with abscess K51.814
... with other complication K51.818
... with unspecified complications K51.819
Ulcerative colitis, unspecified K51.9
... without complications K51.90
... with complications K51.91
... with rectal bleeding K51.911
... with intestinal obstruction K51.912
... with fistula K51.913
... with abscess K51.914
... with other complication K51.918
... with unspecified complications K51.919

For more information on ICD-10, visit the CMS website.

SOURCE
ICD-10-CM 2019: The Official Codebook. American Medical Association, 2018.

Indications

STELARA® (ustekinumab) is indicated for the treatment of adult patients with active psoriatic arthritis. STELARA® can be used alone or in combination with methotrexate (MTX).

STELARA® (ustekinumab) is indicated for the treatment of patients 12 years or older with moderate to severe plaque psoriasis who are candidates for phototherapy or systemic therapy.

STELARA® (ustekinumab) is indicated for the treatment of adult patients with moderately to severely active Crohn’s disease.

STELARA® (ustekinumab) is indicated for the treatment of adult patients with moderately to severely active ulcerative colitis.

Important Safety Information For STELARA®

STELARA® (ustekinumab) is contraindicated in patients with clinically significant hypersensitivity to ustekinumab or to any of the excipients.

Infections

STELARA® may increase the risk of infections and reactivation of latent infections. Serious bacterial, fungal, and viral infections requiring hospitalization or otherwise clinically significant infections were reported. In patients with psoriasis, these included diverticulitis, cellulitis, pneumonia, appendicitis, cholecystitis, sepsis, osteomyelitis, viral infections, gastroenteritis, and urinary tract infections. In patients with psoriatic arthritis, this included cholecystitis. In patients with Crohn’s disease, these included anal abscess, gastroenteritis, ophthalmic herpes zoster, pneumonia, and Listeria meningitis. In patients with ulcerative colitis, these included gastroenteritis, ophthalmic herpes zoster, pneumonia, and listeriosis.

Treatment with STELARA® should not be initiated in patients with a clinically important active infection until the infection resolves or is adequately treated. Consider the risks and benefits of treatment prior to initiating use of STELARA® in patients with a chronic infection or a history of recurrent infection. Instruct patients to seek medical advice if signs or symptoms suggestive of an infection occur while on treatment with STELARA® and consider discontinuing STELARA® for serious or clinically significant infections until the infection resolves or is adequately treated.

Theoretical Risk for Vulnerability to Particular Infections

Individuals genetically deficient in IL-12/IL-23 are particularly vulnerable to disseminated infections from mycobacteria, Salmonella, and Bacillus Calmette-Guerin (BCG) vaccinations. Serious infections and fatal outcomes have been reported in such patients. It is not known whether patients with pharmacologic blockade of IL-12/IL-23 from treatment with STELARA® may be susceptible to these types of infections. Appropriate diagnostic testing should be considered, e.g., tissue culture, stool culture, as dictated by clinical circumstances.

Pre-Treatment Evaluation of Tuberculosis (TB)

Evaluate patients for TB prior to initiating treatment with STELARA®. Do not administer STELARA® to patients with active tuberculosis infection. Initiate treatment of latent TB before administering STELARA®. Closely monitor patients receiving STELARA® for signs and symptoms of active TB during and after treatment.

Malignancies

STELARA® is an immunosuppressant and may increase the risk of malignancy. Malignancies were reported among patients who received STELARA® in clinical studies. The safety of STELARA® has not been evaluated in patients who have a history of malignancy or who have a known malignancy. There have been reports of the rapid appearance of multiple cutaneous squamous cell carcinomas in patients receiving STELARA® who had risk factors for developing non-melanoma skin cancer (NMSC). All patients receiving STELARA®, especially those >60 years or those with a history of PUVA or prolonged immunosuppressant treatment, should be monitored for the appearance of NMSC.

Hypersensitivity Reactions

Hypersensitivity reactions, including anaphylaxis and angioedema, have been reported with STELARA®. If an anaphylactic or other clinically significant hypersensitivity reaction occurs, institute appropriate therapy and discontinue STELARA®.

Reversible Posterior Leukoencephalopathy Syndrome (RPLS)

One case of reversible posterior leukoencephalopathy syndrome (RPLS) was observed in clinical studies of psoriasis and psoriatic arthritis. No cases of RPLS were observed in clinical studies of Crohn’s disease or ulcerative colitis. If RPLS is suspected, administer appropriate treatment and discontinue STELARA®. RPLS is a neurological disorder, which is not caused by an infection or demyelination. RPLS can present with headache, seizures, confusion, and visual disturbances. RPLS has been associated with fatal outcomes.

Immunizations

Prior to initiating therapy with STELARA®, patients should receive all age-appropriate immunizations recommended by current guidelines. Patients being treated with STELARA® should not receive live vaccines. BCG vaccines should not be given during treatment or within one year of initiating or discontinuing STELARA®. Exercise caution when administering live vaccines to household contacts of STELARA® patients, as shedding and subsequent transmission to STELARA® patients may occur. Non-live vaccinations received during a course of STELARA® may not elicit an immune response sufficient to prevent disease.

Concomitant Therapies

The safety of STELARA® in combination with other immunosuppressive agents or phototherapy was not evaluated in clinical studies of psoriasis. Ultraviolet-induced skin cancers developed earlier and more frequently in mice. In psoriasis studies, the relevance of findings in mouse models for malignancy risk in humans is unknown. In psoriatic arthritis studies, concomitant methotrexate use did not appear to influence the safety or efficacy of STELARA®. In Crohn’s disease and ulcerative colitis induction studies, concomitant use of 6-mercaptopurine, azathioprine, methotrexate, and corticosteroids did not appear to influence the overall safety or efficacy of STELARA®.

Noninfectious Pneumonia

Cases of interstitial pneumonia, eosinophilic pneumonia, and cryptogenic organizing pneumonia have been reported during post-approval use of STELARA®. Clinical presentations included cough, dyspnea, and interstitial infiltrates following one to three doses. Serious outcomes have included respiratory failure and prolonged hospitalization. Patients improved with discontinuation of therapy and, in certain cases, administration of corticosteroids. If diagnosis is confirmed, discontinue STELARA® and institute appropriate treatment.

Allergen Immunotherapy

STELARA® may decrease the protective effect of allergen immunotherapy (decrease tolerance) which may increase the risk of an allergic reaction to a dose of allergen immunotherapy. Therefore, caution should be exercised in patients receiving or who have received allergen immunotherapy, particularly for anaphylaxis.

Most Common Adverse Reactions

The most common adverse reactions (≥3% and higher than that with placebo) in adults from psoriasis clinical studies for STELARA® 45 mg, STELARA® 90 mg, or placebo were: nasopharyngitis (8%, 7%, 8%), upper respiratory tract infection (5%, 4%, 5%), headache (5%, 5%, 3%), and fatigue (3%, 3%, 2%), respectively. The safety profile in adolescents with plaque psoriasis through Week 60 was similar to that of adults with plaque psoriasis. In psoriatic arthritis (PsA) studies, a higher incidence of arthralgia and nausea was observed in patients treated with STELARA® when compared with placebo (3% vs 1% for both). In Crohn’s disease induction studies, common adverse reactions (3% or more of patients treated with STELARA® and higher than placebo) reported through Week 8 for STELARA® 6 mg/kg intravenous single infusion or placebo included: vomiting (4% vs 3%). In the Crohn’s disease maintenance study, common adverse reactions (3% or more of patients treated with STELARA® and higher than placebo) reported through Week 44 for STELARA® 90 mg subcutaneous injection or placebo were: nasopharyngitis (11% vs 8%), injection site erythema (5% vs 0%), vulvovaginal candidiasis/mycotic infection (5% vs 1%), bronchitis (5% vs 3%), pruritus (4% vs 2%), urinary tract infection (4% vs 2%) and sinusitis (3% vs 2%). In the ulcerative colitis induction study, common adverse reactions (3% or more of patients treated with STELARA® and higher than placebo) reported through Week 8 for STELARA® 6 mg/kg intravenous single infusion or placebo included: nasopharyngitis (7% vs 4%). In the ulcerative colitis maintenance study, common adverse reactions (3% or more of patients treated with STELARA® and higher than placebo) reported through Week 44 for STELARA® 90 mg subcutaneous injection or placebo included: nasopharyngitis (24% vs 20%), headache (10% vs 4%), abdominal pain (7% vs 3%), influenza (6% vs 5%), fever (5% vs 4%), diarrhea (4% vs 1%), sinusitis (4% vs 1%), fatigue (4% vs 2%), and nausea (3% vs 2%).

Please see full Prescribing Information and Medication Guide for STELARA®. Provide the Medication Guide to your patients and encourage discussion.

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