Billing Overview
It is appropriate to bill for an E/M visit for this day of service along with the infusion procedure. Modifier 25 should be appended to the E/M, indicating that the patient received a significant, separately identifiable E/M service on the same day as his infliximab infusion. This E/M service entailed a:
- Detailed history;
- Detailed examination; and
- Moderate complexity decision making.
CPT 96413 is used for the first hour of a chemotherapy infusion, and 96415 should be reported for each additional hour of a chemotherapy infusion up to eight hours. Because the patient’s infliximab was infused over three hours, it is coded 96413 and 96415×1. HCPCS J1745 is used to code for the infliximab 10 mg; since the patient received 350 mg of infliximab, it should be reported as J1745x35 (35 x 10 = 350 mg).
ICD-10: M07.68 Enteropathic arthropathies, vertebrae and K51.80 is for other ulcerative colitis without complications.
