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October 12, 2015

Avise PG Assay Coding and Billing Guidelines (CM00025)

The Avise PG Assay, developed to support dose optimization and therapeutic decision making for patients diagnosed with rheumatoid arthritis (RA) on methotrexate ('MTX'), has been assigned a unique identifier. To bill an Avise PG service, please provide the following claim information:

  • CPT code 84999 – Unlisted Chemistry Procedure
  • Enter '1' in the Days/Unit field

Enter Assigned ID in the comment/narrative field for the following claim field/types:

  • Loop 2300 NTE 01 for Part A or Loop 2400 or SV101-7 for the 5010A1 837P for Part B
  • Form locator 80 for Part A or Box 19 for paper claim for Part B

Select the appropriate ICD-9-CM diagnosis from the following list:

  • 714.0 - Rheumatoid Arthritis
  • 714.1 - Felty's Syndrome
  • 714.2 - Other Rheumatoid Arthritis With Visceral Or Systemic Involvement
  • 714.30- 714.33 – Juvenile chronic polyarthritis
  • 714.4 – Chronic postrheumatic arthorpathy
  • 714.81-714.89 – Other specified inflammatory polyarthropathies
  • Select the appropriate ICD-9-CM code to indicate methotrexate use
  • V87.41 - Personal history of antineoplastic chemotherapy
  • V87.49 - Personal history of other drug therapy

Note: The V-code diagnosis is required in addition to the appropriate disease/syndrome code.

Select appropriate ICD-10-CM codes:

  • M05.40 – Rheumatoid myopathy with rheumatoid arthritis of unspecified site
  • M05.411 - Rheumatoid myopathy with rheumatoid arthritis of right shoulder
  • M05.412 - Rheumatoid myopathy with rheumatoid arthritis of left shoulder
  • M05.419 - Rheumatoid myopathy with rheumatoid arthritis of unspecified shoulder
  • M05.421 - Rheumatoid myopathy with rheumatoid arthritis of right elbow
  • M05.422 - Rheumatoid myopathy with rheumatoid arthritis of left elbow
  • M05.429 - Rheumatoid myopathy with rheumatoid arthritis of unspecified elbow
  • M05.431 - Rheumatoid myopathy with rheumatoid arthritis of right wrist
  • M05.432 - Rheumatoid myopathy with rheumatoid arthritis of left wrist
  • M05.439 - Rheumatoid myopathy with rheumatoid arthritis of unspecified wrist
  • M05.441 - Rheumatoid myopathy with rheumatoid arthritis of right hand
  • M05.442 - Rheumatoid myopathy with rheumatoid arthritis of left hand
  • M05.449 - Rheumatoid myopathy with rheumatoid arthritis of unspecified hand
  • M05.451 - Rheumatoid myopathy with rheumatoid arthritis of right hip
  • M05.452 - Rheumatoid myopathy with rheumatoid arthritis of left hip
  • M05.459 - Rheumatoid myopathy with rheumatoid arthritis of unspecified hip
  • M05.461 - Rheumatoid myopathy with rheumatoid arthritis of right knee
  • M05.462 - Rheumatoid myopathy with rheumatoid arthritis of left knee
  • M05.469 - Rheumatoid myopathy with rheumatoid arthritis of unspecified knee
  • M05.471 - Rheumatoid myopathy with rheumatoid arthritis of right ankle and foot
  • M05.472 - Rheumatoid myopathy with rheumatoid arthritis of left ankle and foot
  • M05.479 - Rheumatoid myopathy with rheumatoid arthritis of unspecified ankle and foot
  • M05.50 – Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified site
  • M05.511 - Rheumatoid polyneuropathy with rheumatoid arthritis of right shoulder
  • M05.512 - Rheumatoid polyneuropathy with rheumatoid arthritis of left shoulder
  • M05.519 - Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified shoulder
  • M05.521 - Rheumatoid polyneuropathy with rheumatoid arthritis of right elbow
  • M05.522 - Rheumatoid polyneuropathy with rheumatoid arthritis of left elbow
  • M05.529 - Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified elbow
  • M05.531 - Rheumatoid polyneuropathy with rheumatoid arthritis of right wrist
  • M05.532 - Rheumatoid polyneuropathy with rheumatoid arthritis of left wrist
  • M05.539 - Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified wrist
  • M05.541 - Rheumatoid polyneuropathy with rheumatoid arthritis of right hand
  • M05.542 - Rheumatoid polyneuropathy with rheumatoid arthritis of left hand
  • M05.549 - Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified hand
  • M05.551 - Rheumatoid polyneuropathy with rheumatoid arthritis of right hip
  • M05.552 - Rheumatoid polyneuropathy with rheumatoid arthritis of left hip
  • M05.559- Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified hip
  • M05.561 - Rheumatoid polyneuropathy with rheumatoid arthritis of right knee
  • M05.562 - Rheumatoid polyneuropathy with rheumatoid arthritis of left knee
  • M05.569 - Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified knee
  • M05.571 - Rheumatoid polyneuropathy with rheumatoid arthritis of right ankle and foot
  • M05.572 - Rheumatoid polyneuropathy with rheumatoid arthritis of left ankle and foot
  • M05.579 - Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified ankle and foot
  • M05.59 - Rheumatoid polyneuropathy with rheumatoid arthritis of multiple sites
  • Select the appropriate ICD-10-CM code to indicate methotrexate use
  • Z92.21 - Personal history of antineoplastic chemotherapy
  • Z92.29 - Personal history of other drug therapy

Note: The Z-code diagnosis is required in addition to the appropriate disease/syndrome code.

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