Primary Care Coding Alert

Question: The practitioner in our office is billing for Remicade infusions for the first time. We want to verify that we are coding it correctly for maximum reimbursement. We will be using code 90780, along with 90781 to bill for additional hours. Is this correct? Can these codes be used in conjunction with any other codes?

Luke Holt, M.D
St. Lukes Hospital, N.Y.

Answer: Codes 90780 (IV infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour) and 90781 (each additional hour, up to eight [8] hours [list separately in addition to code for primary procedure]) are indeed appropriate to assign. Please note that, in both instances, the infusion service must be provided by the physician or under the direct supervision of the physician.

The J-code that should be assigned for the Remicade is J1750 (injection, iron dextran, 50 mg).

Some carriers also will allow you to bill an office visitbut only when a significant level of an evaluation and management (E/M) service has been provided beyond what is included in the administration of the medication. In other words, if the patient was scheduled for this treatment, it would be expected that you would verify vitals and check with the patient to determine effectiveness and complications of previous treatments. If nothing new or problematic was addressed, there would be no justification for assigning an additional E/M service code.

Naturally, if you administer this medication during the same visit that you initially determine the need and discuss the process with the patient, you may bill for both the E/M and for the infusion service. You will need to add modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code. You may assign the same diagnosis for both procedures.

Please note, however, that some commercial carriers always will bundle the procedure and office visit together. Check with your carriers to determine their payment interpretations in advance.