Gastroenterology Coding Alert

Question: Our gastroenterology practice recently opened an infusion suite on site -- mostly to treat patients with Crohn's disease. Yesterday, an established patient with a treatment plan in place for Plummer-Vinson syndrome secondary to colonic Crohn's reported to the gastroenterologist for a scheduled Remicade infusion and Venofer injection. The gastroenterologist performed a 42- minute, 80 mg Remicade infusion, and also injected 50 mg of Venofer to combat the patient's anemia. What is the correct coding for this encounter?

Montana Subscriber

Answer: On the claim, report the following:

• 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug) for the infusion session

• J1745 (Injection, infliximab, 10 mg) x 8 for the Remicade supply

• 555.1 (Regional enteritis; large intestine) appended to 96413 to represent the patent's Crohn's disease

• J1756 (Injection, iron sucrose, 1 mg) x 50 for the Venofer

• 280.8 (Iron deficiency anemias; other specified iron deficiency anemias) appended to J1756 to represent the patient's Plummer-Vinson syndrome.