RENFLEXIS

A biosimilar to Remicade®, Renflexis® (infliximab-abda) is used to treat a number of autoimmune diseases. Appropriate reimbursement depends on accurate billing and coding. This is a handbook to help you:
First, HCPCS Code: Q5104: This code stands for 10 mg of infliximab-abda (Renflexis). 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 three-hour Renflexis infusion.

3. Diagnosis Codes: Verify that the ICD-10 diagnosis codes on the claim support the use of Renflexis 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 Requirements: Keep thorough medical records that contain the following information: a precise diagnosis and adherence to accepted standards (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. Extra Materials: Refer to the "Billing Codes for RENFLEXIS" guide for more in-depth details. It provides reimbursement assistance resources, example claim forms, and coding insights.

To guarantee correct billing, it's critical to keep abreast of payer-specific regulations and modifications to coding standards. To receive individualized support, call 866-847-3539, which is open Monday through Friday from 8 AM to 8 PM ET.