Stratify Jcv Coding and Billing Guidelines

On January 20, 2012, the US Food and Drug Administration (FDA) approved Stratify JCV Antibody ELISA Test, a diagnostic assay to detect the presence of anti-John Cunningham Virus (JCV) antibodies in patients with multiple sclerosis (MS) or Crohns disease (CD). The presence of anti-JCV antibodies indicates exposure to the JC Virus, which is known to increase the likelihood of developing progressive multifocal leukoencephalopathy (PML) in patients using Tysabri (natalizumab).

Noridian considers a Stratify JCV service reasonable and necessary to detect the presence of JCV antibodies in patients diagnosed with MS and CD. Anti-JCV antibody status, along with the consideration of prior immunosuppressant use and Tysabri treatment duration, are used by physicians to determine whether to initiate or continue treatment with Tysabri.

To bill a Stratify JCV service, please submit the following claim information:
CPT 86711 JC (John Cunningham) virus

  • Enter "1" in the Days/Unit field
  • Select the appropriate ICD-10-CM disease code:
    • G35 - Multiple Sclerosis
    • K50.0 - Crohn's Disease of small intestine
    • K50.00 - Crohn's disease of small intestine without complications
    • K50.01 - Crohn's disease of small intestine with complications
    • K50.011 - Crohn's disease of small intestine with rectal bleeding
    • K50.012 - Crohn's disease of small intestine with intestinal obstruction
    • K50.013 - Crohn's disease of small intestine with fistula
    • K50.014 - Crohn's disease of small intestine with abscess
    • K50.018 - Crohn's disease of small intestine with other complications
    • K50.019 - Crohn's disease of small intestine with unspecified complications
    • K50.1 - Crohn's disease of large intestine
    • K50.10 - Crohn's disease of large intestine without complications
    • K50.11 - Crohn's disease of large intestine with complications
    • K50.111 - Crohn's disease of large intestine with rectal bleeding
    • K50.112 - Crohn's disease of large intestine with intestinal obstruction
    • K50.113 - Crohn's disease of large intestine with fistula
    • K50.114 - Crohn's disease of large intestine with abscess
    • K50.118 - Crohn's disease of large intestine with other complications
    • K50.119 - Crohn's disease of large intestine with unspecified complications
    • K50.8 - Crohn's disease of both small and large intestine
    • K50.80 - Crohn's disease of both small and large intestine without complications
    • K50.81 - Crohn's disease of both small and large intestine with complications
    • K50.811 - Crohn's disease of both small and large intestine with rectal bleeding
    • K50.812 - Crohn's disease of both small and large intestine with intestinal obstruction
    • K50.813 - Crohn's disease of both small and large intestine with fistula
    • K50.814 - Crohn's disease of both small and large intestine with abscess
    • K50.818 - Crohn's disease of both small and large intestine with other complications
    • K50.819 - Crohn's disease of both small and large intestine with unspecified complications
    • K50.9 - Crohn's disease, unspecified
    • K50.90 - Crohn's disease, unspecified without complications
    • K50.91 - Crohn's disease, unspecified with complications
    • K50.911 - Crohn's disease, unspecified with rectal bleeding
    • K50.912 - Crohn's disease, unspecified with intestinal obstruction
    • K50.913 - Crohn's disease, unspecified with fistula
    • K50.914 - Crohn's disease, unspecified with abscess
    • K50.918 - Crohn's disease, unspecified with other complication
    • K50.919 - Crohn's disease, unspecified with inspecified complication

 

Last Updated Jan 17 , 2023