November’s coding answer: 99214-25, 96413, J1745x20, 90775, J2920, 90761-59, J7130. Diagnosis 714.0.
Explore This IssueDecember 2007
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The visit was coded as 99214 because of the level of the history and the examination. Even though the medical decision-making was of high complexity, this does not allow for this visit to be coded as a level five. For an established visit, you need two out of the three components to reach a specific level, and the history and the examination of this visit were at a level four.
The modifier -25 was needed to identify that the visit was separate and significant.
The infusion was coded 96413 for the first hour. (The infusion has to last at least 31 minutes to be considered as one hour of infusion.) The HCPCS code for the drug infliximab is J1745 10 mg, which is why the unit is 20.
The code for the administration of the drug methylprednisolone is 90775 because there cannot be two initial codes from the drug administration family. The HCPCS code for the drug is J2920 40 mg.
A saline infusion cannot be coded with an infusion—unless it is used to flush out the drug after a reaction, as in this case. This is coded as 90761, with a modifier -59 to identify that this was not used to move the drug along but to flush it out of the patient’s system. The HCPCS code for the saline is J7130.