Wiki Using 96413 for non-chemo drugs

[MnTwins29]

I am reviewing chemo infusion records and have this scenario: pt is being treated for MS with Tysabri, with a 1 hour infusion. The infusion CPT code assigned was 96413. I researched the drug and did not find that it is ever used to treat any types of cancer - that MS or Crohn's are the most common diseases treated by this drug. So, I asked why 96413 was used for this procedure and I was told by a nurse that because it is a mononuclear drug that it is considered a chemotherapy drug. Does this make sense? Would this be the classification of the drug with this type of biological makeup, even though the J code (J2323) doesn't fall in the chemo category and it's not used to treat a neoplasm? I have to explain this to a non-medical person so I want to be sure I have this right. Thank you.

 

[dtricia]

Tysabri admin

I have billed this drug to commericials using 96413 for Rheumatology, but never Medicare. Medicare deferred this to the local carrier and ours did not allow. But the use of the CPT code is for infusions of 'monoclonal antibody agents and other biologic response monifiers' and Tysabri falls into this category.
Tricia D