INFLECTRA

A biosimilar to Remicade® (infliximab), INFLECTRA® (infliximab-dyyb) is used to treat a number of autoimmune diseases. Correct reimbursement requires proper coding and billing. The main rules are as follows:
HCPCS Code: Q5103: Biosimilar, injection, infliximab-dyyb, 10 mg.
Example of Billing: Since 10 mg is represented by each unit, bill 10 units for a 100 mg dose of INFLECTRA.
0069-0802-01: INFLECTRA 100 mg single-dose vial is the National Drug Code (NDC).

Diagnosis Codes: The patient's condition should be reflected in the appropriate ICD-10-CM diagnosis codes. The following are typical codes linked to INFLECTRA therapy:
K50.00: Small intestine Crohn's disease without complications.
K50.10: Large intestine Crohn's disease without complications.
K51.90: Complication-free ulcerative colitis.
M05.79: Multiple sites of rheumatoid arthritis with no involvement of organs or systems.
L40.50: Unspecified arthropathic psoriasis.
Codes of Administration: INFLECTRA is given intravenously. The administration may be eligible for the following CPT® codes:
Chemotherapy administration, intravenous infusion technique; single or first substance/drug; up to 1 hour. (96413).
In addition to the code for the principal procedure, each extra hour is listed separately (96415).

Additional Billing Considerations: Pre-Authorization: Prior authorization is required for biologic medicines such as INFLECTRA by many insurance companies. Before starting treatment, make sure that all required approvals have been received.
Documentation: Keep thorough medical records that include the diagnosis, treatment plan, dosage, administration route, and specifics of the administration. This paperwork enables efficient claims processing and substantiates medical necessity.
Please consult Pfizer's INFLECTRA Billing and Coding Guide for complete and current information.
Following these recommendations will help ensure that INFLECTRA therapy is accurately billed and reimbursed.