REMICADE

A monoclonal antibody called Remicade® (infliximab) is used to treat a number of autoimmune diseases. Correct reimbursement requires proper coding and billing. This is a handbook to help you:
1. Code for HCPCS: J1745 This symbol stands for 10 mg of infliximab. Report the quantity of units based on the dosage given when billing. A 200 mg dose, for instance, is equivalent to 20 units (200 mg ÷ 10 mg/unit).

2. Drug Administration CPT Codes:
96413: Administration of chemotherapy, intravenous infusion; duration: up to 1 hour.
96415: For every extra hour of infusion.
For example, you would use 96413 for the first hour and 96415 twice for the next three hours of a Remicade infusion.
3. Diagnosis Codes: Verify that the claim's diagnosis codes (ICD-10) support the usage of Remicade and correspond to the patient's medical condition. Rheumatoid arthritis (M06.9), Crohn's disease (K50.90), and ulcerative colitis (K51.90) are among the frequently diagnosed conditions.

4. Documentation Standards: Keep thorough medical records that contain the following information: a precise diagnosis and compliance with accepted norms (such as the American College of Rheumatology's criteria).
Weight of the patient, if it affects dosage.
A thorough medical history, particularly if previous therapies have been used.
Accurate documentation promotes medical necessity and makes reimbursement procedures run more smoothly.
5. Additional Resources: Refer to the "Billing Guide for REMICADE®," which provides reimbursement support resources, example claim forms, and coding insights, for more thorough information.

To guarantee correct billing, it's critical to keep abreast of payer-specific regulations and modifications to coding standards.