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help with injection code for Cimzia

  1. #1
    Default help with injection code for Cimzia
    Medical Coding Books
    has anyone coded for the use of Cimzia? they use 2 injection sites. can you use cpt cpde 96372 x2 sub q theraputic injection or 96401 x2. The sales rep believes there is better reimbursement with the 96401 but I would like to know what is allowed Also can a level 1 office be charged with a mod 25 with this?

    Help!

    thanks Bridget

  2. #2
    Location
    Columbia, MO
    Posts
    12,841
    Default
    I do not have my book handy and I do not recall the descriptor for the 96401, however you may NOT bill a 99211 with the 25 modifier to give an injection.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Default Cimzia injections
    thanks Debra I did not think so either since you can not do so for a synvisc injection. But I am trying to make sure we are billing the correct injection code for the cizmia since this is a new drug to our practice do you think you may have some extra information tomorrow if I check back? I Have come up with the Jcode but nothing else.

    Thanks
    Bridget

  4. #4
    Location
    Columbia, MO
    Posts
    12,841
    Default
    From what I am able to discern, Cimzia is not a chemotherapy agent it is for RA or Crohns disease. Therefore I would go with
    96372
    96372 59
    And again no 99211 just the addition of the J code and you are done.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Default
    thanks Debra! Have a great day

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