Gastroenterology Coding Alert

Question: A non-Medicare patient with Crohn's in an unspecified site comes to our office for Remicade infusion. The gastroenterologist infuses 300 milligrams of the drug over two hours. How should I report this? What about diagnosis codes?

New Hampshire Subscriber

Answer: On a claim for a private payer, you would:

- report 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug) for the first hour of infusion

- claim add-on code +96415 (... each additional hour, 1 to 8 hours [list separately in addition to code for primary procedure]) for the second hour of infusion

The time you report -should be based only upon the administration time for the infusion,- according to CPT. In other words, CPT bundles services leading up to the infusion and to conclude the infusion (for example, starting the IV and monitoring the patient postinfusion) to the infusion time. You cannot report these services separately or count them toward the infusion time.

As for your diagnosis code, you should link 555.9 (Crohn's disease NOS) to 96413/96415 to prove medical necessity for the infusion.

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

Clinical and coding expertise for this issue provided by Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and former member of the CPT advisory panel; and Linda Parks, MA, CPC, CMC, CMSCS, an independent coding consultant in Atlanta.