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You are here: Home / Articles / Rheumatology Coding Corner Answer: Physical Examination with Infliximab Infusion

Rheumatology Coding Corner Answer: Physical Examination with Infliximab Infusion

July 14, 2016 • By From the College

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July 2016
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CPT: 99214-25, 96413, 96415 x 1, J1745 x 35
ICD-10: M07.68, K51.80

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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).

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ICD-10: M07.68 Enteropathic arthropathies, vertebrae and K51.80 is for other ulcerative colitis without complications.

Filed Under: Billing/Coding, From the College, Practice Management Tagged With: Billing, Coding, infliximab, patient care, physical exam, Practice Management, rheumatologyIssue: July 2016

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