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Remicade infusion

Jill Posted Thu 18th of March, 2010 13:24:28 PM

Remicade infusion for RA or Crohn's. It is not for chemo, but it is in the hig-risk category, so coded as a chemo drug category. The CPT codes are 96413 and 96415 for additional hour. What is the ICD-9 procedure code that goes with that? Thank you!

SuperCoder Answered Thu 18th of March, 2010 16:11:45 PM

We do not have any particular code for the "encounter for non-neoplastic chemotherapy". But if you look at the code V58.1, the "excludes" box says -- "chemotherapy and immunotherapy for nonneoplastic conditions - code to condition". This means, you should code the diagnostic condition for which the infusion is being done as the primary Dx code; in this case, as you have mentioned in the query, probably RA (714.0) or Crohn's (555.9) would be the primary Dx. if the diagnostic reason for the infusion is something else and documented at the clinical note, please code that condition. Also, as the secondary Dx code, you may code V58.69, but that will depend upon whether the infusion was being used for long-term. If not, do not code V58.69.

SuperCoder Answered Fri 19th of March, 2010 09:30:07 AM

Remicade is a immunosuppressant drug so it is drug of choice for RA, Crohn's and etc. So apart from these above ICD-9 codes,the nearest ICD-9 procedural code I could came up was only 99.28 (Injection or infusion of biological response modifier [BRM] as an antineoplastic agent).

Tanya Answered Wed 02nd of November, 2011 19:30:46 PM

A hospital here in our town is now requiring our GI physician to perform a H&P for all patients entering the hospital for Remicade infusions. Will this be a charge our physician can use or will is be considered included (global) in the infusion service since this is the reason the patient is being sent to the hospital?

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