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You are here: Home / Articles / Coding Corner Answer

Coding Corner Answer

August 1, 2007 • By Staff

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The proper way to code this visit is 99214-25, 96413, 96415, J1745 x60-JW, 90775, J2920-, 96401, J9250 x3, 90761-59, J7130, 99214-25.

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  • 99214-25: Because the patient had additional diagnoses of fatigue and joint pain during a scheduled methotrexate injection and infliximab infusion, the physician performed a detailed problem history, detailed examination, and a medical decision making of moderate complexity office visit with a modifier -25 appended.
  • 96413: This drug administration code indicates the infusion was 30 minutes.
  • 96415: This drug administration code indicates the remainder of the infusion time of five minutes.
  • J1745x60-JW: The HCPCs code for infliximab (10 mg) and the amount mixed (60 x10 =600). The JW indicates that wastage existed, and it should be documented in the patient’s chart.
  • 90775: Because there was an allergic reaction to the infliximab, this IV push code was used with the methylprednisolone, sodium succinate. An initial substance/drug code was already used (96413), and this IV push code was used to indicate a new substance. It must be listed separately in addition to the code for the primary procedure.
  • J2920: Injection methylprednisolone sodium succinate, up to 40 mg.
  • 96401: Chemo, injection SC/IM drug administration code for Methotrexate sodium, 5 mg.
  • J9250 x3: Methotrexate sodium, 5 mg to 15 mg was used for this scenario so x3 is used to signify 15 mg.
  • 90761-59: Normal saline was also used to flush out the infliximab from the patients system, and this drug administration code represents each additional hour used. The -59 modifier is used to indicate that this was an additional substance for the allergic reaction.
  • J7130: Hypertonic saline solution, 50 or 100 meq, 20 cc per vial.

Note: Medicare has developed a reimbursement policy for the administration of single-use drugs or discarded biological material for both ASP and CAP drugs, effective July 1, 2007. For billing purposes, the JW modifier is used to indicate discarded medication not administered.

Filed Under: Billing/Coding Tagged With: Coding, E&M, Evaluation and Management, Medical decision makingIssue: August 2007

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