Gastroenterology Coding Alert

Medicare may also do away with G codes

Editorial changes and a series of new codes mean you-ll no longer report 90780-90781 for in-office Remicade infusions for non-Medicare patients. Instead, you should look to newly added -chemotherapy administration- codes 96413-96417. Treat Remicade as a Biologic Response Modifier This year, you needn't limit -chemotherapy administration- codes to patients with a cancer diagnosis. Instead, you will apply such codes -based upon the inherent risk of the agent administration- and -management of the possible toxic effects of the drug, rather then upon the cancer diagnosis most commonly associated with chemotherapy treatment,- according to AMA's CPT Changes 2006: An Insider's View. Agents that fall into this category include -monoclonal antibody agents and other biologic response modifiers---of which Remicade is an example, says Linda Parks, MA, CPC, CMC, CMSCS, an independent coding consultant in Lawrenceville, Ga.

In short: Although Remicade is not a chemotherapy drug, CPT instructs you to report Remicade administration using chemotherapy infusion codes.

Specifically, you will report in-office Remicade infusion (for treatment of Crohn's disease) using two new codes:

- 96413--Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug

- + 96415--... each additional hour, 1 to 8 hours (list separately in addition to code for primary procedure). Pay Attention to Time As in years past, you must keep track of exactly how long a Remicade infusion session lasts. For the first hour of infusion, you should report 96413. Use add-on code 96415 for each subsequent hour, Parks says.

Example: A patient with Crohn's in an unspecified site reports to the office for Remicade infusion. The gastroenterologist infuses 300 milligrams of the drug over a two-hour period. On a claim for a private payer, you would:

- report 96413 for the first hour of infusion
- claim add-on code 96415 for the second hour of infusion
- link a diagnosis of 555.9 (Crohn's disease NOS) to 96413/96415 to prove medical necessity for the infusion.

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

Watch your site of service: Remember, you can only report infusions that take place in the physician's office, not those that occur in a hospital inpatient/outpatient setting. For Medicare, Stick With G Codes--for Now In 2005, Medicare payers instructed providers to use G0359 (Chemotherapy administration, intravenous infusion technique; up to one hour, single or initial substance/drug) and G0360 (Each additional hour, one to eight [8] hours [list separately in addition to code [...]