Diagnosis 733.0, 714.0 (ICD-9), or M81.0, Z87.310, M06.89 (ICD-10)*
The modifier -25 is used to indicate that the patient received a significant, separately identifiable evaluation and management (E/M) service on the same day as her Reclast infusion. This E/M service entailed:
- Detailed history
- History of present illness: extensive
- Review of system: extended
- Past family social history: one
- Expanded problem-focused examination
- Moderate complexity decision making
- Number of problems—two problems worsening: extensive
- ••Amount of data reviewed—labs were reviewed: limited
- ••Level of risk—prescription drug management: moderate
- 96365 Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance of drug); initial, up to 1 hour
The code 96365 is used to code for the 20-minute Reclast infusion. For the infusions to be considered as an initial hour, the infusion has to be at least 16 minutes long. Because the patient received 5 mg of Reclast, the correct way to code this is Q2051 x 5.
As of July 1, 2013, Q2051 has replaced the HCPCS codes of J3488 Reclast, J3487 Zometa, and J3590 generic Reclast.
*FYI: The ICD 10 M81.0 is for age-related osteoporosis without current pathological fracture. The Z87.310 is for the personal history of (healed) osteoporosis fracture. M06.89 is for other specified rheumatoid arthritis, multiple sites. October 1, 2014, is the implementation deadline for the new diagnosis code set ICD-10.
