Gastroenterology Coding Alert

Question: Our office performs Remicade infusion sessions for our patients with Crohn's disease. We report the Remicade supply with J1745, but we often receive rejections when using this code. Should we report a different HCPCS code?

North Carolina Subscriber

Answer: CPT gave Remicade its own supply code in 2000, J1745 (Injection, infliximab, 10 mg). However, not all payers recognize the code.

What to do? Call some of the payers that have rejected your J1745 claims and ask them what code you should report for Remicade supply. Some may prefer a local code for Remicade, or even J3490 (Unclassified drugs).

Also remember to accurately document the patient's condition when reporting Remicade supply, because the carrier will usually not accept the claim unless the documentation proves: abdominal cramping/pain severity, diarrhea severity/frequency, extraintestinal manifestation, the gastroenterologist's description of conventional treatments attempted, and overall patient well-being.

Tip: Get yourself a copy of the Crohn's Disease Activity Index, a system of measurement that objectively measures how a patient is responding to treatment changes. The index, which is an invaluable tool for coding of all Crohn's-related procedures, takes into account a number of factors including frequency of bowel movements, pain, well-being, weight changes, blood counts, and other symptoms related to Crohn's disease.