Make the Change:
CMS Delivers on 96413/96415
Published on Mon Mar 27, 2006
You should rely on new chemo codes for Remicade infusions CMS has fulfilled experts- expectations by eliminating chemotherapy codes G0359 and G0360 for 2006. Gastro practices providing Remicade infusions for Crohn's (555.9) patients will want to take notice. 96413/96415 Are Now Universal From now on, you should report 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug) and +96415 (... each additional hour, 1 to 8 hours [list separately in addition to code for primary procedure]) exclusively for Remicade infusions. CPT introduced these codes for 2006, but until recently, Medicare payers had not indicated that they would accept the codes.
The verdict is in: Recent posts by Empire Medicare (Part B provider for New York and New Jersey), National Heritage Insurance Company (California, Maine, Massachusetts, New Hampshire and Vermont) and others confirm that CMS has eliminated codes G0359 and G0360--which you should have used throughout 2005 to report Remicade infusions--in favor of 96413 and 96415.
'Chemo- Shouldn't Confuse You Although 96413 and 96415 specify -chemotherapy administration,- the codes also apply to infusions of -monoclonal antibody agents and other biologic response modifiers---and Remicade falls into this category, says Linda Parks, MA, CPC, CMC, CMSCS, an independent coding consultant in Lawrenceville, Ga. Therefore, 96413 and 96415 are appropriate for Remicade infusion. Count the Minutes When reporting 96413 and 96415, remember to track the time -based only upon the administration time for the infusion,- according to the AMA CPT Changes 2006: An Insider's View. Therefore, you cannot count time spent starting the IV and monitoring the patient post-infusion, for example. Such services are -bundled- into the infusion time. Don't Miss Out on Drug Supplies If your office supplies the Remicade used during infusion, you may report this separately using J1745 (Injection, infliximab, 10 mg). The physician may also use saline to infuse the pharmaceutical, says Matthew Lautzenheiser, senior administrative manager at Johns Hopkins Medicine in Baltimore. You can bill for that supply using J7050 (Infusion, normal saline solution, 250 cc) for every 250 cc the physician administers.
Note: Not all payers will reimburse for the saline supplies, Lautzenheiser says. Follow This Example Suppose you provide Remicade infusion in your office for a Medicare patient with Crohn's disease. You infuse a total of 300 milligrams of the drug, along with saline, over a period of 125 minutes.
In this case, you should report:
- 96413 for the first 60 minutes of infusion
- 96415 for the additional 65 minutes of infusion
- J1745 x 30 for the Remicade supplies (the drug comes in 100-mg bottles, but you should report usage per 10 [...]
