Oncology & Hematology Coding Alert

Question: We provide infusion services for patients being treated with Remicade. Should we use chemotherapy or other therapy administration codes?

Colorado Subscriber

Answer: Payers are free to determine which non-chemotherapy agents they pair with chemotherapy administration codes, which reflect a higher level of skill and therefore a higher fee than non-chemo admin codes. You're likely to find that payers instruct you to report Remicade infusions using chemotherapy infusion codes, such as 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug) and +96415 (Chemotherapy administration, intravenous infusion technique; each additional hour [List separately in addition to code for primary procedure]).

Colorado MAC TrailBlazer offers a Chemotherapy job aid that states "Chemotherapy administration codes apply to parenteral administration of ... substances such as monoclonal antibody agents." It goes on to state infliximab is "commonly considered to fall under the category of monoclonal antibodies" (www.trailblazerhealth.com/Publications/Job%20Aid/ChemotherapyAdministrationPartB.pdf).  This content is taken from Medicare Claims Processing Manual, Chapter 12, Section 30.5.D (www.cms.gov/manuals/downloads/clm104c12.pdf).

Reminder: You should report J1745 (Injection infliximab, 10 mg) for the Remicade.