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humira injection cpt need for 80 mg

Lina Posted Fri 24th of May, 2013 16:36:19 PM

Hi, need your help on humira injection, that the patient brought to the office and doctor injected twice x40 mg

I thought of J0135 4units
96372 59
not sure what icd9 code?

SuperCoder Answered Tue 28th of May, 2013 18:19:37 PM

96372 - Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular -- There’s no need for mod 59 based on the info given here. Also note that individual payers can define which codes qualify for non-chemo and chemo admin codes, but given that Humira can be self-administered, you’re unlikely to find a payer who thinks it qualifies for the higher paying chemo admin codes. Payers may vary on whether they reimburse admin because Humira is considered “usually self-administered.”

J0135x4 – Injection, adalimumab, 20 mg -- Be sure not to charge for J0135. The patient brought it in so you should not claim reimbursement for it. FWIW, payers may not reimburse usually self-administered drugs even if you had provided it.

ICD-9 can’t be selected based on the information given here.

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