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Remicade coding scenario

  1. #1
    Default Remicade coding scenario
    Medical Coding Books

    Can somebody tell me if the Benadryl IVPB administration in the following scenario is billable? This is done in the doctors suite. Thank you!

    Premed w/Tylenol ES po. Benadryl 50 mg IVPB over 30 min. NS KVO. Remicade 400mg IV 8:45 - 11:00. 11:00 infusion complete.

    I code the following:

    96413 - Remicade 1st hr.
    96415 - Remicade 2nd hr.
    96366 - Benadryl IV infusion 1st hr
    J1745 - Remicade
    J1200 - Benadryl

  2. #2
    Columbia, MO
    If the Benadrly was hung as a piggyback infusion then it is codeable as a concurrent infusion. A concurrent infusion is used when two separate bags are infused through the same line. The one billed as the concurrent will always have a unit of 1.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Thank you both for your answers! The Benadryl was an IVPB however, no start/stop time was given, only that is was a premedication and infused over 30 minutes. Therefore, I'm assuming it was not concurrent with the Remicade but then again why would it be an IVPB if it was infused by itself?

    In regards to the administration codes for Remicade I agree, this is not a chemo drug but the instructions I referenced through the American Society of Clinical Oncology and also our local Trailblazer carrier state that chemotherapy administration codes can be used to report the administration of antineoplastic monoclonal antibody agents one of which is infliximab (Remicade).

    This has been pretty confusing for me as you can see. Anymore insight would be GREATLY appreciated!
    Lisa Incaudo, CPC

  4. #4
    Columbia, MO
    you do not need the start and stop times for a piggy back billed as a concurrent infusion only the documentation that it was hung as a piggyback, it is infusing with the primary bottle so the primary bottle in this case the remicade will have the start and stop times. the concurrent is bill only as a 1 unit.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Thank you Debra!
    Lisa Incaudo, CPC

  6. Default Remicaid as chemo infusion
    This is a late entry but for clarification, Remicaid should be billed as a chemo infusion. This typically takes 2 hours, so should be billed as 96413 x 1 and 96415 x 1.


  7. Default
    The Remicade should be billed as a chemo infusion per Medicare guidelines even though it is not a J-9 code. I've included the website below that states this. Also, because the Benadryl was given IVP, it would not be an infusion code. Just because an IVP runs for 30 minutes, if it's charted as an IVP it's needs to be charged as an IVP, regardless of the time. If it did not state IVP and it had a start and stop time, then you can charge it as an infusion. However, if it does not state IVP but it also does not have a start and a stop time then you have to charge it as an IVP. You can only charge an infusion if there is a start and stop time documented. I would charge the scenario as 96413, 96415, and 96375.

  8. Default
    I think I would use 96367, additional sequential infusion of a new drug,if it was done via piggy back, I don't think I would use the code for IV push (96374)

  9. #9
    Everett, WA
    I'm so glad this thread was created and happy to see active participation. Our doctor bills for the same type scenario and uses the 96366 for the Benadryl, but I think this needs to be changed to the 96367. And yes we do use the 96413 and 96414 codes ALTHOUGH thru research this needs to be verified with the carrier as some might want the 96365 and 96367 codes. It could be payer specific and if this be the case reimbursement is about half of what the 96413 and 96415 yields. I haven't come across these payers yet...
    Suzanne E. Byrum CPC

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