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Marlene Posted Fri 29th of August, 2014 12:14:13 PM

Wondering how to know when you can use the 96413/96415 for high risk medications. Is there a list? For example Remicade is that a drug you can bill with these codes? Also if fluids are given before and after how do you bill for those as far as CPT codes? Fluids from 0815-900 and 1115-1130 Remicade from 0900-1110 running piggyback.


SuperCoder Answered Tue 02nd of September, 2014 07:02:59 AM


SuperCoder Answered Tue 02nd of September, 2014 07:02:59 AM
SuperCoder Answered Tue 02nd of September, 2014 07:20:02 AM

Thank you for your question.

96413 and 96415 are the proper infusion codes for Remicade.
Remicade from 0900-1110 would be 96413, 96415 x1.

Clinical Responsibility

The physician administers the chemotherapy drugs intravenously as a single dose and the infusion may continue up to a maximum time of one hour.

Codes 96360-96379, 96401, 96402, 96409-96425, 96521-96523 are not intended to be reported by the physician in the facility setting. If a significant, separately identifiable office or other outpatient Evaluation and Management service is performed, the appropriate E/M service (99201-99215, 99241-99245, 99354-99355) should be reported using modifier 25 in addition to 96360-96549. For same day E/M service, a different diagnosis is not required.

If performed to facilitate the infusion or injection, the following services are included and are not reported separately:

a. Use of local anesthesia

b. IV start

c. Access to indwelling IV, subcutaneous catheter or port

96415: Chemotherapy administration, intravenous infusion technique; each additional hour (List separately in addition to code for primary procedure)
Each additional hour of intravenous chemotherapy infusion following the first hour of administration (reported by CPT code 96413) is reported by CPT code 96415 which is an add–on code.

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