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Explore This IssueDecember 2012
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- D: High: The patient has one established problem worsening—severe rheumatoid arthritis—and one new problem with work up—adverse reaction to infusion. The amount of data reviewed or ordered was none. The patient’s level of risk was high because the patient has severe rheumatoid arthritis.
- C: 96413: The infliximab infusion was 35 minutes along before it was stopped because of an adverse reaction. The first hour of an infusion must be at least 16 minutes long in order to qualify as an infusion. If the first hour is less than 16 minutes, it must be coded as a chemotherapy push—96401. Descriptions of each code are below:
- 96413—Chemotherapy administration, intravenous infusion technique; up to one hour, single or initial substance/drug
- 96401—Chemotherapy administration, subcutaneous or intramuscular, nonhormonal antineoplastic
- C: 96375: The push would be coded as a subsequent push because only one initial code in the drug administration family—96413—can be billed during a session.
- 96375—each additional sequential intravenous push of a new substance/drug (list separately in addition to code for primary procedure)
- D: 96361-59: As stated in answer three above, only one initial code is allowed per session. The infusion of hydration is only allowed if the saline is used to remove the drug from a patient in the case of an adverse reaction. The modifier -59 is required to get this charge reimbursed.
- C: 20: The code for the infliximab is 20—J1745 10 mg. To arrive at the number of units to be billed, divide 200 mg—the amount of the drug used—by 10.
- J1745–Injection, infliximab, 10 mg