Gastroenterology Coding Alert

You should rely on new chemo codes for Remicade infusions

CMS has fulfilled experts- expectations by eliminating chemotherapy codes G0359 and G0360 for 2006. Gastro practices providing Remicade infusions for Crohn's (555.9) patients will want to take notice.

96413/96415 Are Now Universal

From now on, you should report 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug) and +96415 (... each additional hour, 1 to 8 hours [list separately in addition to code for primary procedure]) exclusively for Remicade infusions. CPT introduced these codes for 2006, but until recently, Medicare payers had not indicated that they would accept the codes.

The verdict is in: Recent posts by Empire Medicare (Part B provider for New York and New Jersey), National Heritage Insurance Company (California, Maine, Massachusetts, New Hampshire and Vermont) and others confirm that CMS has eliminated codes G0359 and G0360--which you should have used throughout 2005 to report Remicade infusions--in favor of 96413 and 96415.

'Chemo- Shouldn't Confuse You

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 Lawrenceville, Ga. Therefore, 96413 and 96415 are appropriate for Remicade infusion.

Count the Minutes

When reporting 96413 and 96415, remember to track the time -based only upon the administration time for the infusion,- according to the AMA CPT Changes 2006: An Insider's View. Therefore, you cannot count time spent starting the IV and monitoring the patient post-infusion, for example. Such services are -bundled- into the infusion time.

Don't Miss Out on Drug Supplies

If your office supplies the Remicade used during infusion, you may report this separately using J1745 (Injection, infliximab, 10 mg). The physician may also use saline to infuse the pharmaceutical, says Matthew Lautzenheiser, senior administrative manager at Johns Hopkins Medicine in Baltimore. You can bill for that supply using J7050 (Infusion, normal saline solution, 250 cc) for every 250 cc the physician administers.

Note: Not all payers will reimburse for the saline supplies, Lautzenheiser says.

Follow This Example

Suppose you provide Remicade infusion in your office for a Medicare patient with Crohn's disease. You infuse a total of 300 milligrams of the drug, along with saline, over a period of 125 minutes.

In this case, you should report:

- 96413 for the first 60 minutes of infusion
- 96415 for the additional 65 minutes of infusion
- J1745 x 30 for the Remicade supplies (the drug comes in 100-mg bottles, but you should report usage per 10 mg)
- J7050 x 1 for each 250 mg of saline supply.

Link a diagnosis of 555.9 (Crohn's disease NOS) to 96413/96415.

Something else to consider: If a patient presents with signs and symptoms of volume depletion or dehydration, and the supervising physician determines the patient must be hydrated prior to administering Remicade, you can also report 90760 (Intravenous infusion, hydration; initial, up to 1 hour) for the first 60 minutes of infused hydration and +90761 (... each additional hour, up to 8 hours [list separately in addition to code for primary procedure]) for each subsequent hour. Be certain to attach the appropriate diagnosis code reflecting the patient's signs/symptoms of volume depletion or dehydration. Otherwise, administering saline during a standard Remicade infusion is bundled into 96413 and 96415, Lautzenheiser says.

Remember: You can only report infusions that take place in the physician's office, not those that occur in a hospital inpatient/outpatient setting.

Learn more: For complete information on new-for-2006 codes 96413 and 96415, see -Remake Your Remicade Reporting in 2006 With New Administration Codes- in the January 2006 Gastroenterology Coding Alert.