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Old 05-04-2010, 09:51 AM
krssy70 krssy70 is offline
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Question Drug: Remicade


PATIENT A:
Patient comes to our chemotherapy facility for administration of the drug Remicade and the patient does not have cancer, however this drug is infused the same way chemotherapy is admistered. How would you code this encounter? FYI: Remicade is a non-chemo drug? Infusion time is 1 hour.

CPT 96413 - diag v58.11, 555.9

PATIENT B:
same scenreio as above, although this patient has a breast cancer.

CPT 96413 - diag v58.11, 555.9, 174.8
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Old 05-04-2010, 10:32 AM
daisy3663 daisy3663 is offline
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Remicade is a monoclonal antibody so you can code it as 96413 with dx's 555.9 and V58.12 for patient A. Pt B can be coded the same way. Pt's can have two primary dx's but certain drugs are used to treat each dx. I wouldn't tie the breast cancer code to the Remicade if the Remicade isn't being used to treat the cancer.
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Old 05-04-2010, 10:51 AM
krssy70 krssy70 is offline
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Thank you very much for your response. So you would use v58.12 instead of v58.11 because this drug is a non-chemotherapy drug? And would you use the 555.9 as the prime diag and the v58.12 as secondary diag? Because we always use v58.11 as prime when a patient is receiving an infusion.

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Old 05-04-2010, 11:47 AM
daisy3663 daisy3663 is offline
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Well our Ingenix scrubs like for us to not have V codes as primary dx's so if there is a dx that we are using along with a V code then they would like for us to use it first and the V code second. Don't know why but I hear from others that it could be either way.
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Old 05-04-2010, 12:01 PM
krssy70 krssy70 is offline
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I understand the primary V code discrepancy, for us it is always billed as primary if the patient is receiving an infusion....However can you please explain why you would use v58.12 instead of v58.11? Only becuase we have always used v58.11.

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Old 05-05-2010, 02:51 PM
daisy3663 daisy3663 is offline
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Sure, we use V58.12 for monoclonal antibodies and V58.11 for the other chemotherapy drugs.
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