Janssen CarePath

Savings Program

Express Enrollment

Xarelto®

Janssen CarePath Provider Portal

SIGN UP LOG IN

  • Benefits investigations & prior authorizations
  • Enroll eligible patients in Savings Program
  • View Savings Program transactions
Menu

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 document 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 or 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 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, 2018.

Click below for ICD-10 Codes.

ATRIAL FIBRILLATION

ICD-10 Indication ICD-10 Code
Paroxysmal atrial fibrillation I48.0
Persistent atrial fibrillation I48.1
Chronic atrial fibrillation I48.2
Unspecified atrial fibrillation I48.91

DEEP VEIN THROMBOSIS

ICD-10 Indication ICD-10 Code
Acute embolism and thrombosis of deep veins of lower extremity I82.4XX
Acute embolism and thrombosis of unspecified deep veins of lower extremity I82.40X
... Deep vein thrombosis NOS  
... DVT NOS  
... right lower extremity I82.401
... left lower extremity I82.402
... lower extremity, bilateral I82.403
... unspecified lower extremity I82.409
Acute embolism and thrombosis of unspecified femoral vein I82.419*
Acute embolism and thrombosis of unspecified iliac vein I82.429*
Acute embolism and thrombosis of unspecified popliteal vein I82.439*
Acute embolism and thrombosis of unspecified proximal lower extremity I82.4Y9*
* Please refer to the ICD-10 book for the lateral and bilateral codes
Acute embolism and thrombosis of unspecified tibial vein I82.449*
Acute embolism and thrombosis of other specified deep vein of unspecified lower extremity I82.499*
Acute embolism and thrombosis of unspecified deep veins of unspecified distal lower extremity I82.4Z9*
* Please refer to the ICD-10 book for the lateral and bilateral codes
Chronic embolism and thrombosis of deep veins of lower extremity I82.5XX
Use additional code, if applicable, for associated long-term (current) use of anticoagulants (Z79.01)
... unspecified deep veins of right lower extremity I82.501
... unspecified deep veins of left lower extremity I82.502
... unspecified deep veins of lower extremity, bilateral I82.503
... unspecified deep veins of unspecified lower extremity I82.509
Chronic embolism and thrombosis of other specified deep vein of lower extremity I82.59X
... other specified deep vein of right lower extremity I82.591
... other specified deep vein of left lower extremity I82.592
... other specified deep vein of lower extremity, bilateral I82.593
... other specified deep vein of unspecified lower extremity I82.599
Chronic embolism and thrombosis of right femoral vein I82.511
Chronic embolism and thrombosis of left femoral vein I82.512
Chronic embolism and thrombosis of femoral vein, bilateral I82.513
Chronic embolism and thrombosis of unspecified femoral vein I82.519
Chronic embolism and thrombosis of right iliac vein I82.521
Chronic embolism and thrombosis of left iliac vein I82.522
Chronic embolism and thrombosis of iliac vein, bilateral I82.523
Chronic embolism and thrombosis of unspecified iliac vein I82.529
Chronic embolism and thrombosis of right popliteal vein I82.531
Chronic embolism and thrombosis of left popliteal vein I82.532
Chronic embolism and thrombosis of popliteal vein, bilateral I82.533
Chronic embolism and thrombosis of unspecified popliteal vein I82.539
Chronic embolism and thrombosis of unspecified deep veins of right proximal lower extremity I82.5Y1
Chronic embolism and thrombosis of unspecified deep veins of left proximal lower extremity I82.5Y2
Chronic embolism and thrombosis of unspecified deep veins of proximal lower extremity, bilateral I82.5Y3
Chronic embolism and thrombosis of unspecified deep veins of unspecified proximal lower extremity I82.5Y9
Chronic embolism and thrombosis of tibial vein I82.54X
... right tibial vein I82.541
... left tibial vein I82.542
... tibial vein, bilateral I82.543
... unspecified tibial vein I82.549
Chronic embolism and thrombosis of unspecified deep veins of distal lower extremity I82.5ZX
... right distal lower extremity I82.5Z1
... left distal lower extremity I82.5Z2
... distal lower extremity, bilateral I82.5Z3
... unspecified deep veins of unspecified distal lower extremity I82.5Z9
Chronic embolism and thrombosis of deep veins of upper extremity I82.72X
... Brachial vein  
... Radial vein  
... Ulnar vein  
Use additional code, if applicable, for associated long-term (current) use of anticoagulants (Z79.01)
... right upper extremity I82.721
... left upper extremity I82.722
... upper extremity, bilateral I82.723
... unspecified upper extremity I82.729
Acute embolism and thrombosis of deep veins of upper extremity I82.62X
... Brachial vein  
... Radial vein  
... Ulnar vein  
... right upper extremity I82.621
... left upper extremity I82.622
... upper extremity, bilateral I82.623
... unspecified upper extremity I82.629

JOINT REPLACEMENT

ICD-10 Indication ICD-10 Code
Presence of unspecified artificial hip joint Z96.649
... right artificial hip joint Z96.641
... left artificial hip joint Z96.642
... artificial hip joint, bilateral Z96.643
Presence of unspecified artificial knee joint Z96.659
... right artificial knee joint Z96.651
... left artificial knee joint Z96.652
... artificial knee joint, bilateral Z96.653

PULMONARY EMBOLISM

ICD-10 Indication ICD-10 Code
Septic pulmonary embolism with acute cor pulmonale I26.01
Saddle embolus of pulmonary artery with acute cor pulmonale I26.02
Acute cor pulmonale NOS I26.09
   
Code first underlying infection
Other pulmonary embolism without acute cor pulmonale I26.99
Acute pulmonary embolism NOS I26.99
Pulmonary embolism NOS I26.99
Air embolism following infusion, transfusion and therapeutic injection, initial encounter T80.0XXA
Complication of other artery following a procedure, not elsewhere classified, initial encounter T81.718A
Complication of vein following a procedure, not elsewhere classified, initial encounter T81.72XA
Embolism of cardiac prosthetic devices, implants and grafts, initial encounter T82.817A
Embolism of vascular prosthetic devices, implants and grafts, initial encounter T82.818A
Septic pulmonary embolism with acute cor pulmonale I26.01
Code first underlying infection
Septic pulmonary embolism without acute cor pulmonale I26.90
Code first underlying infection
Saddle embolus of pulmonary artery with acute cor pulmonale I26.02
Saddle embolus of pulmonary artery without acute cor pulmonale I26.92
Other pulmonary embolism with acute cor pulmonale I26.09
Other pulmonary embolism without acute cor pulmonale I26.99
Acute pulmonary embolism NOS I26.99
Pulmonary embolism NOS I26.99
Chronic pulmonary embolism I27.82
Use additional code, if applicable, for associated long-term (current) use of anticoagulants (Z79.01)
Other secondary pulmonary hypertension
... Pulmonary hypertension NOS 		I27.2
Code also associated underlying condition
Cor pulmonale (chronic)
... Cor pulmonale NOS 		I27.81
Pulmonary heart disease, unspecified I27.9
Other diseases of pulmonary vessels I28.8
Other specified pulmonary heart diseases I27.89
Disease of pulmonary vessels, unspecified I28.9

For more information on the transition to ICD-10, visit the CMS Web site.

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

INDICATIONS

XARELTO® is indicated to reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation (AF).

There are limited data on the relative effectiveness of XARELTO® and warfarin in reducing the risk of stroke and systemic embolism when warfarin therapy is well controlled.

XARELTO® is indicated for the treatment of deep vein thrombosis (DVT). XARELTO® is indicated for the treatment of pulmonary embolism (PE). XARELTO® is indicated for the reduction in the risk of recurrence of DVT and/or PE in patients at continued risk for recurrent DVT and/or PE after completion of initial treatment lasting at least 6 months.

XARELTO® is indicated for the prophylaxis of DVT, which may lead to PE in patients undergoing knee or hip replacement surgery.

XARELTO® is indicated for the prophylaxis of venous thromboembolism (VTE) and VTE-related death during hospitalization and post hospital discharge in adult patients admitted for an acute medical illness who are at risk for thromboembolic complications due to moderate or severe restricted mobility and other risk factors for VTE, and not at high risk of bleeding.

XARELTO® is indicated, in combination with aspirin, to reduce the risk of major cardiovascular events (cardiovascular [CV] death, myocardial infarction [MI], and stroke) in patients with chronic coronary artery disease (CAD) or peripheral artery disease (PAD).

Important Safety Information for XARELTO®

WARNING: (A) PREMATURE DISCONTINUATION OF XARELTO® INCREASES THE RISK OF THROMBOTIC EVENTS,
(B) SPINAL/EPIDURAL HEMATOMA

A. Premature discontinuation of XARELTO® increases the risk of thrombotic events

Premature discontinuation of any oral anticoagulant, including XARELTO®, increases the risk of thrombotic events. If anticoagulation with XARELTO® is discontinued for a reason other than pathological bleeding or completion of a course of therapy, consider coverage with another anticoagulant.

B. Spinal/epidural hematoma

Epidural or spinal hematomas have occurred in patients treated with XARELTO® who are receiving neuraxial anesthesia or undergoing spinal puncture. These hematomas may result in long-term or permanent paralysis. Consider these risks when scheduling patients for spinal procedures. Factors that can increase the risk of developing epidural or spinal hematomas in these patients include:

  • Use of indwelling epidural catheters
  • Concomitant use of other drugs that affect hemostasis, such as non-steroidal anti-inflammatory drugs (NSAIDs), platelet inhibitors, other anticoagulants, see Drug Interactions
  • A history of traumatic or repeated epidural or spinal punctures
  • A history of spinal deformity or spinal surgery
  • Optimal timing between the administration of XARELTO® and neuraxial procedures is not known

Monitor patients frequently for signs and symptoms of neurological impairment. If neurological compromise is noted, urgent treatment is necessary.

Consider the benefits and risks before neuraxial intervention in patients anticoagulated or to be anticoagulated for thromboprophylaxis.

CONTRAINDICATIONS

  • Active pathological bleeding
  • Severe hypersensitivity reaction to XARELTO® (eg, anaphylactic reactions)

WARNINGS AND PRECAUTIONS

  • Increased Risk of Thrombotic Events after Premature Discontinuation: Premature discontinuation of any oral anticoagulant, including XARELTO®, in the absence of adequate alternative anticoagulation increases the risk of thrombotic events. An increased rate of stroke was observed during the transition from XARELTO® to warfarin in clinical trials in atrial fibrillation patients. If XARELTO® is discontinued for a reason other than pathological bleeding or completion of a course of therapy, consider coverage with another anticoagulant.
  • Risk of Bleeding: XARELTO® increases the risk of bleeding and can cause serious or fatal bleeding. Promptly evaluate any signs or symptoms of blood loss and consider the need for blood replacement. Discontinue in patients with active pathological hemorrhage.
    • An agent to reverse the anti-factor Xa activity of rivaroxaban is available. Because of high plasma protein binding, rivaroxaban is not dialyzable.
    • Concomitant use of other drugs that impair hemostasis increases risk of bleeding. These include aspirin, P2Y12 platelet inhibitors, dual antiplatelet therapy, other antithrombotic agents, fibrinolytic therapy, NSAIDs, selective serotonin reuptake inhibitors (SSRIs), and serotonin norepinephrine reuptake inhibitors (SNRIs).
    • Risk of Hemorrhage in Acutely Ill Medical Patients at High Risk of Bleeding: Acutely ill medical patients with the following conditions are at increased risk of bleeding with the use of XARELTO® for primary VTE prophylaxis: history of bronchiectasis, pulmonary cavitation, or pulmonary hemorrhage; active cancer (ie, undergoing acute, in-hospital cancer treatment); active gastroduodenal ulcer or history of bleeding in the three months prior to treatment; or dual antiplatelet therapy. XARELTO® is not for use for primary VTE prophylaxis in these hospitalized, acutely ill medical patients at high risk of bleeding. 
  • Spinal/Epidural Anesthesia or Puncture: When neuraxial anesthesia (spinal/epidural anesthesia) or spinal puncture is employed, patients treated with anticoagulant agents for prevention of thromboembolic complications are at risk of developing an epidural or spinal hematoma, which can result in long-term or permanent paralysis. To reduce the potential risk of bleeding associated with concurrent use of XARELTO® and epidural or spinal anesthesia/analgesia or spinal puncture, consider the pharmacokinetic profile of XARELTO®. Placement or removal of an epidural catheter or lumbar puncture is best performed when the anticoagulant effect of XARELTO® is low; however, the exact timing to reach a sufficiently low anticoagulant effect in each patient is not known. An indwelling epidural or intrathecal catheter should not be removed before at least 2 half-lives have elapsed (ie, 18 hours in young patients aged 20 to 45 years and 26 hours in elderly patients aged 60 to 76 years), after the last administration of XARELTO®. The next dose should not be administered earlier than 6 hours after the removal of the catheter. If traumatic puncture occurs, delay the administration of XARELTO® for 24 hours. Monitor frequently to detect signs or symptoms of neurological impairment, such as midline back pain, sensory and motor deficits (numbness, tingling, or weakness in lower limbs), or bowel and/or bladder dysfunction. Instruct patients to immediately report any of the above signs or symptoms. If signs or symptoms of spinal hematoma are suspected, initiate urgent diagnosis and treatment including consideration for spinal cord decompression even though such treatment may not prevent or reverse neurological sequelae.
  • Use in Patients with Renal Impairment:
    • Nonvalvular Atrial Fibrillation: Periodically assess renal function as clinically indicated (ie, more frequently in situations in which renal function may decline) and adjust therapy accordingly. Consider dose adjustment or discontinuation in patients who develop acute renal failure while on XARELTO®. Clinical efficacy and safety studies with XARELTO® did not enroll patients with CrCl <30 mL/min or end-stage renal disease (ESRD) on dialysis.
    • Treatment of Deep Vein Thrombosis (DVT), Pulmonary Embolism (PE), and Reduction in the Risk of Recurrence of DVT and of PE: In patients with CrCl <30 mL/min, rivaroxaban exposure and pharmacodynamic effects are increased compared to patients with normal renal function. There are limited clinical data in patients with CrCl 15 to <30 mL/min; therefore, observe closely and promptly evaluate any signs or symptoms of blood loss in these patients. There are no clinical data in patients with CrCl <15 mL/min (including patients on dialysis); therefore, avoid the use of XARELTO® in these patients. Discontinue XARELTO® in patients who develop acute renal failure while on treatment.
    • Prophylaxis of Deep Vein Thrombosis Following Hip or Knee Replacement Surgery: In patients with CrCl <30 mL/min, rivaroxaban exposure and pharmacodynamic effects are increased compared to patients with normal renal function. There are limited clinical data in patients with CrCl 15 to <30 mL/min; therefore, observe closely and promptly evaluate signs or symptoms of blood loss in these patients. There are no clinical data in patients with CrCl <15 mL/min (including patients on dialysis); therefore avoid the use of XARELTO® in these patients. Discontinue XARELTO® in patients who develop acute renal failure while on treatment.
    • Prophylaxis of Venous Thromboembolism in Acutely Ill Medical Patients at Risk for Thromboembolic Complications Not at High Risk of Bleeding: In patients with CrCl <30 mL/min, rivaroxaban exposure and pharmacodynamic effects are increased compared to patients with normal renal function. There are limited clinical data in patients with CrCl 15 to <30 mL/min; therefore, observe closely and promptly evaluate any signs or symptoms of blood loss in these patients. There are no clinical data in patients with CrCl <15 mL/min (including patients on dialysis); therefore, avoid the use of XARELTO® in these patients. Discontinue XARELTO® in patients who develop acute renal failure while on treatment.
    • Reduction of Risk of Major Cardiovascular Events in Patients with Chronic CAD or PAD: For patients with CrCl <15 mL/min, no data are available, and limited data are available for patients with a CrCl of 15 to 30 mL/min. In patients with CrCl <30 mL/min, a dose of 2.5 mg XARELTO® twice daily is expected to give an exposure similar to that in patients with moderate renal impairment (CrCl 30 to <50 mL/min), whose efficacy and safety outcomes were similar to those with preserved renal function. Clinical efficacy and safety studies with XARELTO® did not enroll patients with end-stage renal disease (ESRD) on dialysis.
  • Use in Patients with Hepatic Impairment: No clinical data are available for patients with severe hepatic impairment. Avoid use in patients with moderate (Child-Pugh B) and severe (Child-Pugh C) hepatic impairment or with any hepatic disease associated with coagulopathy, since drug exposure and bleeding risk may be increased.
  • Use with P-gp and Strong CYP3A Inhibitors or Inducers: Avoid concomitant use of XARELTO® with known combined P-gp and strong CYP3A inhibitors or inducers.
  • Risk of Pregnancy-Related Hemorrhage: In pregnant women, XARELTO® should be used only if the potential benefit justifies the potential risk to the mother and fetus. XARELTO® dosing in pregnancy has not been studied. The anticoagulant effect of XARELTO® cannot be monitored with standard laboratory testing. Promptly evaluate signs or symptoms suggesting blood loss (eg, a drop in hemoglobin and/or hematocrit, hypotension, or fetal distress).
  • Patients with Prosthetic Heart Valves: Safety and efficacy of XARELTO® have not been studied in patients with prosthetic heart valves. Use of XARELTO® is not recommended in these patients.
  • Acute PE in Hemodynamically Unstable Patients/Patients Who Require Thrombolysis or Pulmonary Embolectomy: Initiation of XARELTO® is not recommended acutely as an alternative to unfractionated heparin in patients with pulmonary embolism who present with hemodynamic instability or who may receive thrombolysis or pulmonary embolectomy.
  • Increased Risk of Thrombosis in Patients with Antiphospholipid Syndrome: Direct-acting oral anticoagulants (DOACs), including XARELTO®, are not recommended for use in patients with triple-positive antiphospholipid syndrome (APS).  For patients with APS (especially those who are triple positive [positive for lupus anticoagulant, anticardiolipin, and anti-beta 2-glycoprotein I antibodies]), treatment with DOACs has been associated with increased rates of recurrent thrombotic events compared with vitamin K antagonist therapy. 

DRUG INTERACTIONS

  • Combined P-gp and strong CYP3A inhibitors increase exposure to rivaroxaban and may increase risk of bleeding.
  • Combined P-gp and strong CYP3A inducers decrease exposure to rivaroxaban and may increase risk of thromboembolic events.
  • XARELTO® should not be used in patients with CrCl 15 to <80 mL/min who are receiving concomitant combined P-gp and moderate CYP3A inhibitors (eg, erythromycin) unless the potential benefit justifies the potential risk.
  • Coadministration of enoxaparin, warfarin, aspirin, clopidogrel, and chronic NSAID use may increase risk of bleeding.
  • Avoid concurrent use of XARELTO® with other anticoagulants due to increased bleeding risk, unless benefit outweighs risk. Promptly evaluate signs or symptoms of blood loss if patients are treated concomitantly with aspirin, other platelet aggregation inhibitors, or NSAIDs.

USE IN SPECIFIC POPULATIONS

  • Pregnancy: The limited available data on XARELTO® in pregnant women are insufficient to inform a drug-associated risk of adverse developmental outcomes. Use XARELTO® with caution in pregnant patients because of the potential for pregnancy-related hemorrhage and/or emergent delivery. The anticoagulant effect of XARELTO® cannot be reliably monitored with standard laboratory testing. Consider the benefits and risks of XARELTO® for the mother and possible risks to the fetus when prescribing to a pregnant woman.
    • Fetal/Neonatal adverse reactions: Based on the pharmacologic activity of Factor Xa inhibitors and the potential to cross the placenta, bleeding may occur at any site in the fetus and/or neonate.
    • Labor or delivery: The risk of bleeding should be balanced with the risk of thrombotic events when considering use in this setting.
    • There are no adequate or well-controlled studies of XARELTO® in pregnant women, and dosing for pregnant women has not been established. Post-marketing experience is currently insufficient to determine a rivaroxaban-associated risk for major birth defects or miscarriage.
  • Lactation: Rivaroxaban has been detected in human milk. There are insufficient data to determine the effects of rivaroxaban on the breastfed child or on milk production. Consider the developmental and health benefits of breastfeeding along with the mother’s clinical need for XARELTO® and any potential adverse effects on the breastfed infant from XARELTO® or from the underlying maternal condition.
  • Females and Males of Reproductive Potential: Females of reproductive potential requiring anticoagulation should discuss pregnancy planning with their physician.
  • Pediatric Use: Safety and effectiveness in pediatric patients have not been established.

OVERDOSAGE

  • Overdose of XARELTO® may lead to hemorrhage. Discontinue XARELTO® and initiate appropriate therapy if bleeding complications associated with overdosage occur. An agent to reverse the anti-factor Xa activity of rivaroxaban is available.

ADVERSE REACTIONS IN CLINICAL STUDIES

  • Most common adverse reactions with XARELTO® were bleeding complications.

Please see full Prescribing Information, including Boxed WARNINGS for XARELTO®.

cp-62551v5