Gastroenterology Coding Alert

Learn how to cope with claims specifying multiple drug infusionsThe bottom line is this -- you won't get paid for Remicade services unless you have a handle on drug-therapy coding.Follow these expert tips to determine which codes to report for Remicade as well as other drug administrations, and you'll reap the reimbursement benefit.Tip 1: Sharpen Your ICD-9 SpecificityYou know that when you report Remicade infusions, you must include a diagnosis code, but do you know how to ramp up your specificity? Our experts show you how.Important: You should always report based on your physician's documentation, not based on what carriers will pay. However, you should be aware of what you will commonly see for Remicade infusions. For instance, you will likely see the following diagnoses among your carrier's approved list:• 555.0-555.9 -- Regional enteritis (Crohn's)• 556.0-556.9 -- Ulcerative colitis• 565.1 -- Anal fistula• 569.81 -- Fistula of intestine, excluding rectum and anus• 696.0 -- Psoriatic arthropathy (which you will report with 720.81, Inflammatoryspondylopathies in diseases classified elsewhere)• 714.0 -- Rheumatoid arthritis• 720.0 -- Ankylosing spondylitis."Code 555.9 is the one I see 98 percent of the time," says Joyce Carpenter, CPC, OGS, MCMC, billing department lead of Internal Medicine Associates in Anchorage, Alaska. "But if you can get a more specific code than 555.9, then by all means use it."Example: Don't forget that you can expand on the patient's story by adding a secondary diagnosis, such as ankylosing spondylitis (720.0), Carpenter adds.Tip 2: Keep Track of Time Keeping track of exactly how long a Remicade infusion session lasts is also vital to maximum ethical reimbursement. Physicians should document the start and stop time in the chart.
If your physician infuses a Crohn's patient with Remicade, use 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug) for the first hour. Use add-on code +96415 (... each additional hour [list separately in addition to code for primary procedure]) for every subsequent hour.
- Remember: Although 96413 and 96415 specify "chemotherapy administration," the codes also apply to infusions of "monoclonal antibody agents and other biologic response modifiers" -- and Remicade falls into this category, says Linda Parks, MA, CPC, CMC, CMSCS, an independent coding consultant in Atlanta.
- Good idea: Also, when reporting 96413 and 96415, remember to track the time "based only upon the administration time for the infusion," according to the AMA's CPT Changes 2006: An Insider's View. Therefore, you cannot count time spent starting the IV and monitoring the patient post-infusion, for example. Most carriers bundle these services into the infusion time.Example: The patient undergoes a three-hour Remicade infusion and takes an oral Benadryl upon arrival. For this, you'll report one unit of 96413 to represent the first hour [...]