Scenario 1: Direct Billing
A 70-year-old female patient with rheumatoid arthritis in multiple joints and positive rheumatoid factor returns to the practice for her fourth infusion of infliximab with the nurse practitioner (NP). She reports no fevers, cough, dyspnea or concurrent illness. She rates the severity of her joint pain at 6 on a 10-point scale. The patient is currently on a non-steroidal anti-inflammatory drug (NSAID), weekly methotrexate subcutaneous injections, folic acid and famotidine. No changes were made in the patient’s medications. The patient’s weight is 130 lbs.
The patient is administered 50 mg of diphenhydramine as a prophylactic against a possible drug reaction to infliximab. Her IV line is started at 10 a.m. The intravenous infliximab 300 mg by infusion is started at 10:15 a.m. and ends at 12:26 p.m.
Is billing this service allowable under Medicare nonphysician rules?
A. Yes
B. No
C. Maybe
Scenario 2: Incident-to Billing
A 66-year-old male patient with rheumatoid arthritis in multiple joints and positive rheumatoid factor returns to the practice for his fifth infliximab infusion with the physician assistant (PA). The rheumatologist is in the practice acting as the supervising physician. The patient reports no fevers, cough, dyspnea or concurrent illness. He rates the severity of his joint pain at 7 on a 10-point scale. The patient is currently on an NSAID and weekly methotrexate subcutaneous injections. No changes were made in the patient’s medications. The patient’s weight is 265 lbs.
The patient is administered 50 mg of diphenhydramine as a prophylactic measure against a possible drug reaction to infliximab. His IV line is started at 10 a.m. The intravenous infliximab 600 mg by infusion is started at 10:05 a.m. and ends at 11:14 a.m.
Is billing this service allowable under Medicare nonphysician rules?
A. Yes
B. No
C. Maybe
