Coding Corner Answer

Take the challenge.

Question 1

96413, J1745 x20, 96361-59, J7000 x2, 96375, J2930

  • 96413—Chemotherapy administration, intravenous infusion; up to one hour, single or initial substance is coded for the 25 minutes of the infusion. As long as the infusion is for 20 minutes or more, the infusion code can be billed. The rule for drug administration codes states that only one initial code of the drug administration family can be used during the same visit.
  • 96361—Intravenous infusion, hydration is billed because saline was used to flush the drug from the patient’s system. Each additional hour can be billed with the modifier -59.
  • 96375—Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular; each additional hour is billed for the methylprednisolone push.

Question 2

  • 99215—Time is used as the key factor in determining the level of this visit. If the physician and the patient or family spends more than 50% of the visit (face to face) discussing counseling and/or coordination of care, then time can be the key factor in determining the level of the visit. As per the 2011 CPT for a level-five established visit, physicians typically spend 40 minutes face to face with the patient and/or family.

Question 3

Thirty Medicare patients for claims base reporting or 30 patients with at least two Medicare patients.

There are six measures in the RA measure group:

  • Measure 108: Rheumatoid Arthritis (RA): Disease Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis
  • Measure 176: Rheumatoid Arthritis (RA): Tuberculosis Screening
  • Measure 177: Rheumatoid Arthritis (RA): Periodic Assessment of Disease Activity
  • Measure 178: Rheumatoid Arthritis (RA): Functional Status Assessment
  • Measure 179: Rheumatoid Arthritis (RA): Assessment and Classification of Disease Prognosis
  • Measure 180: Rheumatoid Arthritis (RA): Glucocorticoid Management

Question 4

D. Extensive. Medical decision making is determined by points. Established problems that are stable are one point each. A new problem with additional workup planned is worth four points. All of the points add up to five. Four or more points equal an extensive level for diagnoses or treatment options.


    • Kay says

      for 750mg Orencia infusion – J0129 X 75 (the HCPCS code is for 10mg); NS fluid that was hung such as J7050 (we don’t charge but do list on claim); length of time for infusing a complex medication – less than 90mins – 96413 (if longer than 90mins then add 96415). Does patient receive any premeds other than orally? if pushed into IV access then 96375 would be added. Hope that is helpful.

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