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Explore This IssueJuly 2013
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Answer: 96375, J1200 x1, 96413, 96415×1, J1745 –EJ x 20, Diagnosis 714.0
Infliximab is considered a chemotherapy infusion. Even though the push for the methylprednisolone was done first, it should be coded as a subsequent code. As per CPT coding guidelines, only one initial code may be used within the drug administration family. It would not matter that the 96375 was done first. It is permissible to code the 96413 as the initial code because this is the main procedure. CPT 96413 is used to code 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 starts for the infusion when the actual medication starts, not when the IV port is inserted. HCPCS code J1745 is the drug code for infliximab 10 mg. Because the patient received 200 mg of infliximab, the correct way to code this treatment is J1745x20 (20×10=200 mg). The EJ modifier should be added to the drug code for subsequent claims for a defined course of therapy (e.g., EPO, sodium hyaluronate, and infliximab). The EJ modifier is an informational modifier except for the Medicare carrier Novitas Solutions, where it is always required to identify the subsequent doses of the above medications.