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STACY Posted Mon 13th of November, 2017 11:57:05 AM
We do in office infusions. I have a Medicare Part B (Novitas) patient who received Ocrevus by a specialty pharmacy, therefore it is not billed by our office. But the patient did receive 125mg of Solumedrol given in 100mls of a NaCLbag sequentially to the Ocrevus. She also received Diphenhydramine (J1200) as a push. Please inform me on the correct coding to Medicare. Here are the codes I believe should be billed: J1200 96413 96415 96411 J2930 96367 Is this correct? Is there a modifier I am missing?
SuperCoder Answered Tue 14th of November, 2017 11:47:09 AM
Hi, the information provided is not sufficient for us to give the exact codes. Since these are time-based procedures, we would be needing some more information of the procedure along with the diagnosis/es. Thank you.
STACY Posted Tue 14th of November, 2017 13:38:05 PM
Here is the time line: J1200 Diphenhydramine 25 mg 8.29a J2930 Solumedrol 125mg 8:31a saline flush 8.31 and 8:46 Ocrevus 300mg 8:48 - 11:48 All infused through a mechanical pump Diagnosis is G35 Is this enough information?
SuperCoder Answered Wed 15th of November, 2017 11:40:28 AM
Please provide details of the start and end times of both, the infusion as well as the push. Also, complete details of the medical record would be appreciated and will help to list the correct codes. Thank you.
STACY Posted Wed 15th of November, 2017 15:28:23 PM
Here is the time line all done in one sitting in the doctors office: J1200 Diphenhydramine 25 mg 8.29a-8:30 Saline flush 8:31-8:33J2930 Solumedrol 125mg 8:33a-8:46a Ocrevus 300mg 8:48 - 11:48 All infused through a mechanical pump Diagnosis is G35 Miltiple Sclerosis Relapsing/Remitting. Is this enough information? I'm not exactly sure what you are needing out of the medical record? Can you be more specific? I am just confirming the coding I mentioned originally is correct for Novitas and if a modifier is needed.
SuperCoder Answered Thu 16th of November, 2017 23:32:50 PM

CPT codes

96413 –Ocrevus for 1 hour

96415 – Ocrevus for additional 1 hour

96367 – administration code for Solumedrol administration

96375 – administration code for Diphenhydramine

 

HCPCS codes

J1200 - Diphenhydramine 25 mg

J2930 - Solumedrol 125mg

C9494 X300 - Ocrevus 300mg

 

96413 and +96415 codes are used for anti-neoplastic drug and as well as monoclonal antibody agents and Ocrevus (Ocrelizumab) is a humanized monoclonal antibody designed to selectively target CD20-positive B cells.

 

Thank you.

STACY Posted Fri 17th of November, 2017 17:48:58 PM
Wouldn't the push code be 96411 due to 96413 being the initial code and not 96375?
SuperCoder Answered Mon 20th of November, 2017 06:01:32 AM

CPT 96411 [Chemotherapy administration; intravenous, push technique, each additional substance/drug (List separately in addition to code for primary procedure)] is used if chemotherapeutic medication is administered, 96375 is used for Diphenhydramine (J1200) because Diphenhydramine is not a chemotherapeutic drug.

STACY Posted Mon 20th of November, 2017 15:02:26 PM
I realize the Diphenhydramine is not a Chemotherapeutic drug, but I was under the understanding that if the initial admin code was under the Chemotherapeutic classification then you use the push code that is also under that classification. Therefore if the admin code is 96413 then the push code billed would be 96411. If the 96365 admin was billed then the 96375 would be the appropriate push code. Are you stating the actual push drug billed determines what push code is used no matter the what classification the main drug infused and initial admin code is billed?
SuperCoder Answered Tue 21st of November, 2017 06:23:23 AM

Hi,

Yes, actual push drug billed determines what admin code is used no matter the what classification the main drug infused and initial admin code is billed.

Please also check the slide no. 29-32 of below link:

http://namas.co/wp-content/uploads/2013/12/Infusions.pdf

Thanks

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