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Explore This IssueJanuary 2009
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99214-25, 96413, J1745 x 20, 90775, J1200, 90761-59, J7040, Diagnosis 714.0 The visit would be considered as 99214.
Although the history was only problem focused, the exam was detailed, and the medical decision making was of moderate complexity—making this a level-four visit. You only need two out of three components for an established visit. A modifier -25 is needed on the office visit because it was separate and significant to the infusion.
The infusion of infliximab would be coded as 96413, one unit. Because of the adverse reaction, the infusion was halted, and saline was used to flush out the infliximab. In this circumstance, the code 90761 with a modifier -59 can be billed. The “subsequent” code has to be used because only one initial code is allowed—here it is the 96413 code—when billing in the drug administration category. The modifier -59 should be billed to alert the carrier that the saline was used to flush out the drug and was not just used to move the drug along. The 90775 was used to bill for the push of diphenhydramine for the adverse reaction of the infliximab.
Again, the “subsequent” code is used because of the initial coding rule.