Coding Hint: Watch for ‘add-ons’ during Remicade sessions
| Question: An established patient with a plan of care in place for his Crohn’s disease of the ileum reports to the gastroenterologist for a Remicade infusion. The infusion started at 10:00 a.m. and ended at 11:42. The patient reported nausea during the infusion, so the gastroenterologist administered 200 mg of Benadryl from 10:41 to 10:52. How should I report this encounter? |
Answer: This claim has a lot of moving parts; you can code for both the Remicade and the Benadryl administrations. Because your Benadryl infusion time was so short, however, you should not report an infusion code for that service.
Follow this two-step guidance on how to ethically maximize this claim:
Step 1 — Remicade: The total infusion time for the Remicade treatment was an hour and 42 minutes. Represent this time with the following:
• 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug) for the first hour
• +96415 (… each additional hour [List separately in addition to code for primary procedure]) for the remaining 42 minutes
• 555.0 (Regional enteritis; small intestine) linked to 96413 and +96415 to represent the patient’s condition
• J1745 (Injection, infliximab, 10 mg) x 20 for the supply of Remicade.
Step 2 — Benadryl: Payers will allow separate codes for any antiemetics the gastroenterologist provides during Remicade infusions. Since the Benadryl infusion took less than 15 minutes, however, you should consider it a push and report +96375 (Therapeutic, prophylactic, ordiagnostic injection [specify substance or drug]; each additional sequential intravenous push of a new substance/drug [List separately in addition to code for primary procedure]) with 555.0 attached. Also, report J1200 (Injection, diphenhydramine HCl, up to 50 mg) for the Benadryl supply.
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