CPT Codes: 96413, 96415 x 3, J9312 x 5, 96375, J2920
Diagnoses: M05.79
Coding Rationale
As of Jan. 1, 2019, the Healthcare Common Procedure Coding System (HCPCS) code for rituximab was changed from J9310 rituximab 100 mg, to the new HCPCS code J9312 (injection, rituximab, 100 mg). According to a Verywell Health article written on Dec. 28, 2017, many patients have an adverse reaction to this drug, ranging from mild to major. This usually occurs within the first hour of the infusion; therefore, the infusion is administered as a slow drip to minimize any reaction to the rituximab.
Note: The saline is not billable because it was used in the infusion and included in the Relative Value Unit (RVU) of the reimbursement for the infusion. CPT code 96365 is billed twice for the methylprednisolone sodium succinate (J2920).
The ICD-10 diagnostic code M05.79 is for rheumatoid arthritis of multiple sites, rheumatoid factor positive, without organ or systems involvement.
For questions or additional information on coding and documentation guidelines, contact Melesia Tillman, CPC-I, CPC, CRHC, CHA, via email at [email protected] or call 404-633-3777 x820.
Editor’s note: This article was updated on April 25, 2019, to correct two of the CPT codes in the answer.