ollielooya
True Blue
Hello colleagues,
I've posted this same question to another outside forum I frequent but figured this dedicated rheumatology forum might yield quicker answers. Here's the case:
Pt. receives Remicade infusion in the doctor's office over a period of l hour and 48 minutes = 96413 and 96415.
Additionally 125 mg. of Dexamethasone was infused over a half hour.
The Dexamethasone is not a usual medication to give during the Remicade treatment, and is only given due to a significant flare up of patient's condition or for a reaction to the medication. The use of code 96366 is being denied as "representing an add on code that is only considered for reimbursement when reported with a primary procedure that is also considered for separate reimbursement." They have their own edits per the National Reimbursement Forum and 96366 is not on their list when accompanying CPT codes 96413 and 96415.
Can someone more knowledgable with this type of procedure please validate whether or not our doctor's choice of code 96366 is the best choice? Would not 96367 ACTUALLY fit this type of service and in light of this a corrected claim be the proper way to go as this particular carrier does accept 96367 with 96413/96415. Just wanting some opinions before taking any recommendation to the physician.
I may need additional followup from the list members from responses received.
I've posted this same question to another outside forum I frequent but figured this dedicated rheumatology forum might yield quicker answers. Here's the case:
Pt. receives Remicade infusion in the doctor's office over a period of l hour and 48 minutes = 96413 and 96415.
Additionally 125 mg. of Dexamethasone was infused over a half hour.
The Dexamethasone is not a usual medication to give during the Remicade treatment, and is only given due to a significant flare up of patient's condition or for a reaction to the medication. The use of code 96366 is being denied as "representing an add on code that is only considered for reimbursement when reported with a primary procedure that is also considered for separate reimbursement." They have their own edits per the National Reimbursement Forum and 96366 is not on their list when accompanying CPT codes 96413 and 96415.
Can someone more knowledgable with this type of procedure please validate whether or not our doctor's choice of code 96366 is the best choice? Would not 96367 ACTUALLY fit this type of service and in light of this a corrected claim be the proper way to go as this particular carrier does accept 96367 with 96413/96415. Just wanting some opinions before taking any recommendation to the physician.
I may need additional followup from the list members from responses received.