Designing a coding gameplan for a soon-to-launch infused biologic
Case Study:
Establishing Proper Coding to Accelerate Patient Access
This case study highlights how Magnolia Market Access supported a biopharma company in ensuring proper billing codes for a soon-to-launch infused biologic, streamlining claims processing and patient access.
Key highlights include:
- Challenge: Address the lack of appropriate billing codes for a new biologic’s unique infusion procedure, preventing claim denials and delays.
- Approach:
- Reviewed existing diagnosis (ICD-10-CM) and CPT codes for FDA-approved indications and identified gaps in billing codes for the infusion procedure.
- Assisted in applications for new ICD-10 and HCPCS (J-code) billing codes.
- Developed a reimbursement guide and tools to support field reimbursement teams, healthcare providers, and patients.
- Outcome: Secured new diagnosis and procedure codes, reducing administrative burdens and improving access. Delivered practical tools like prior authorization forms, coding flashcards, and educational materials to ensure successful launch support.
Download the case study to learn how proactive coding strategies can accelerate patient access and provider adoption.
