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- C—This claim cannot be coded without querying the infusion nurse and physician. There must be documentation of the patient’s weight to document the correct dosage of the medication to be given to the patient. Also the start time and the completion time of the infusion must be documented to know which drug administration code can be billed.
- C—There is no documentation of the medical necessity for an E/M visit. The drug denosumab, although it is a monoclonal antibody, does not meet the medical necessity for the higher chemotherapy injection code.
- D—Adalimumab is on the Self-Administrated Drug (SAD) list. CMS will reimburse for the office administration of a drug only if it is not a drug that a patient usually could administer himself. A list of the drugs on the SAD list can be found on your Medicare Administrative Carrier’s (MAC) website.
- B—The drug ibandronate sodium injection is administrated via an intravenous push. A nursing visit (99211) cannot be billed with any drug-administrated code, because the work of the nurse is built into the relative value unit (RVU) of the fee schedule.
For questions or additional information on coding and documentation guidelines, contact Melesia Tillman, CPC-I, CPC, CRHC, CHA, via email at mtillman@rheumatology.org or call 404-633-3777 x820.