Diagnosis: Optic neuritis.
Treatment: Procedure code J1599- injection, immune globulin, intravenous, non-lyophilized (example liquid), not otherwise specified, 500mg [milligrams].

The insurer denied coverage for Procedure code J1599.

The denial is overturned.

This is a male patient who developed bilateral optic neuritis following an upper respiratory infection and sinusitis. Bilateral optic neuritis following upper respiratory infection (URI) and sinusitis, negative oligoclonal band, neuromyelitis optica (NMO), and negative myelin oligodendrocyte glycoprotein (MOG) was noted. The plan was: repeat test, reconsider differential diagnosis, repeat image; and treatment with corticosteroid, plasmapheresis, or intravenous immunoglobulin (IVIG). It was noted the patient was quite impaired at the time.

Another visit indicated the patient presented for follow-up on optic neuritis, cervical magnetic resonance imaging (MRI) and thoracic MRI with and without contrast revealed mild multi-level discogenic degenerative changes, and no identified abnormal enhancement of the thoracic or cervical spinal cord.

"Twenty-three patients received treatment with IVIG and 24 matched patients who did not receive treatment with IVIG were followed as controls. All patients had visual acuity 20/400 or worse in the affected eye. There was significant improvement in the IVIG group with 18/23 (78%) subjects reaching near normal vision (20/30 or better), compared with the control group with only 3/24 (12.5%) responding similarly" (Tselis, A. et al. 2008).

Dale in an editorial discussing treatment of optic neuritis if steroids fail notes that "If the patient fails to respond adequately in the 1st week of corticosteroids, further adjunctive therapies can be considered such as intravenous immunoglobulin (IVIG)...

This patient a good candidate for procedure code J1599- injection, immune globulin, intravenous, non-lyophilized (example liquid), not otherwise specified, 500mg [milligrams] and has been refractory to other treatment. Procedure code J1599 is the best available treatment for this patient at this time.

He is a good candidate and has been refractory to other treatment. Being rare, high quality peer review medical articles are not available. The available literature supports the requested service is likely to be more beneficial than any other standard treatment or procedure.

The carrier's denial of coverage for procedure code J1599- injection, immune globulin, intravenous, non-lyophilized (example liquid), not otherwise specified, 500mg should be overturned.