Wiki need help with remicade coding/billing

[akrug]

iv started at 1:45. 2:00 10 units of remicade, 1 unit saline started. 2:15 blood pressure spikes dr. examines patient. 2:25 remicaide stopped new line saline unit started,50 mg benadryl given thru new line. 3:00 patient discharged and sent to pcp.
my question is how do i bill for this? how do i detremine the amount of remicade used?
any help on this would be appreciated.

 

[hnroberts]

Remicade is a single dose vial, so you have to bill for the vial used, even though part of it was wasted. The Remicade was run over 25 min, so that makes it a 96365, you would also bill a 96375 for the benadryl IVP. I would add Dx code 995.29 (Unspec. adverse effect of other drug, medicinal and biological substance) as the primary Dx for the Bendadryl. You can also add a 53 mod to the 96365 since the procedure was discontinued. Hope this helps some and good luck!

 

[akrug]

yes it does help. thank you so much.

 

[Susan R]

Remicade Infusion Coding

iv started at 1:45. 2:00 10 units of remicade, 1 unit saline started. 2:15 blood pressure spikes dr. examines patient. 2:25 remicaide stopped new line saline unit started,50 mg benadryl given thru new line. 3:00 patient discharged and sent to pcp.
my question is how do i bill for this? how do i detremine the amount of remicade used?
any help on this would be appreciated.

Hi AKRUG;

Here is a link with some great billing information:

http://www.centocoraccessone.com/ce...emicade/guide/reimbursement/reimbursement.jsp

Also, check with you local Medicare carrier; I know we bill using the chemo coding (96413 and 96415) because that's what our local Medicare carrier says is covered.

You can check with your local Medicare and other insurance carriers and find out what they want you to use for Remicade coding.

I hope this helps; good luck. ~ Susan R, CPC, CPMA, CEMC future CHONC