A/B MAC (A) Action

The contractor is responsible for the following:

• It accepts HCPCS codes for inpatient services; 

• It edits to require HCPCS codes with Revenue Code 0636. Multiple iterations of the revenue code are possible with the same or different HCPCS codes. It does not edit units except to ensure a numeric value;

• It reduces charges forwarded to Pricer by the charges for hemophilia clotting factors in revenue code 0636. It retains the charges and revenue and HCPCS codes for CWF; and 

• It modifies data entry screens to accept HCPCS codes for hospital (including CAH) swing bed, and SNF inpatient claims (bill types 11X, 12X, 18x, 21x and, 22x).

The September 1, 1993, IPPS final rule (58 FR 46304) states that payment will be made for the blood clotting factor only if diagnosis code for hemophilia is included on the bill. 

Inpatient blood-clotting factors are covered only for beneficiaries with hemophilia. One of the following hemophilia diagnosis codes must be reported on the claim for payment to be made for blood clotting factors.

ICD-9- CM code	Description
286.0	Congenital factor VIII disorder
286.1	Congenital factor IX disorder
286.2	Congenital factor XI deficiency
286.3	Congenital deficiency of other clotting factors
286.4	von Willebrands' disease

Effective for discharges August 1, 2001 through the implementation of ICD-10, payment may be made if a diagnosis codes from either Table 1 or Table 2 is reported is reported:

ICD-9- CM code	Description
286.5	Hemorrhagic disorder due to intrinsic circulating anticoagulants (terminate effective September 30, 2011)
286.7	Acquired coagulation factor deficiency

Table 3 - Effective for discharges on October 1, 2011, through the implementation of ICD-10 payment may be made if a diagnosis code from any of Table 1, Table 2 or Table 3 is reported:

ICD-9- CM code	Description
286.52	Acquired hemophilia
286.53	Antiphospholipid antibody with hemorrhagic disorder
286.59	Other hemorrhagic disorder due to intrinsic circulating anticoagulants, antibodies, or inhibitors

Effective for discharges on or after the implementation of ICD-10-CM, the following codes are applicable, and payment may be made for blood clotting factors only if a hemophilia code from the range D66 - D68.4 is reported

A crosswalk of ICD 9 to ICD10 hemophilia diagnosis codes follows:

ICD-9- CM code	Description	ICD-10- CM Code	Description
286.0	Congenital factor VIII disorder	D66	Hereditary factor VIII deficiency
286.1	Congenital factor IX disorder	D67	Hereditary factor IX deficiency
286.2	Congenital factor XI deficiency	D68.1	Hereditary factor XI deficiency
286.3	Congenital deficiency of other clotting factors	D68.2	Hereditary deficiency of other clotting factors
286.4	von Willebrands' disease	D68.0	Von Willebrand's disease
286.5	Hemorrhagic disorder due to intrinsic circulating anticoagulants (terminate effective September 30, 2011)	N/A
286.52	Acquired hemophilia	D68.311	Acquired hemophilia
286.53	Antiphospholipid antibody with hemorrhagic disorder	D68.312	Antiphospholipid antibody with hemorrhagic disorder
286.59	Other hemorrhagic disorder due to intrinsic circulating anticoagulants, antibodies, or inhibitors	D68.318	Other hemorrhagic disorder due to intrinsic circulating anticoagulants, antibodies, or inhibitors
286.7	Acquired coagulation factor deficiency	D68.32	Antiphospholipid antibody with hemorrhagic disorder
286.7	Acquired coagulation factor deficiency	D68.4	Acquired coagulation factor deficiency