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Explore This IssueJanuary 2010
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99213-25, 96413, 96415×1, J1745x20 Diagnosis 714.0
Modifier -25 is used to indicate that the patient received a significant, separately identifiable E/M service on the same day as her infliximab infusion. This E/M service is coded this way because:
- The history is expanded problem-focused;
- The examination is expanded problem-focused; and
- The medical decision making is of low complexity.
Infliximab is considered a chemotherapy infusion. The code 96413 is used for the first hour of a chemotherapy infusion and 96415 is used to code each additional hour of a chemotherapy infusion, up to eight hours. Because the patient’s infliximab was infused over two hours and 10 minutes, it is coded 96413 and 96415×1. The time for the infusion starts when the actual medication is started, not when the IV port is inserted. J1745 is the drug code for infliximab 10 mg. Because the patient received 200 mg of infliximab, the correct way to code this is J1745x20 (20 x 10 mg=200 mg).