Clinical Context
A 58-year-old patient with moderately to severely active ulcerative colitis who has had inadequate response to or loss of response to conventional therapies presents to an infusion center for administration of intravenous golimumab. The patient arrives for an induction or maintenance infusion ordered by a gastroenterologist. Pre-infusion nursing assessment includes verification of identity, review of allergies, vital signs, and current medications. The infusion pharmacist verifies the physician order for J1602 (golimumab, 1 mg, IV), calculates the total dose based on the prescribed mg/kg or fixed dosing regimen, and prepares the product under aseptic technique. The infusion nurse obtains baseline vitals, establishes IV access, administers premedication if indicated (e.g., for prior infusion reactions), and initiates the IV infusion at the prescribed rate. During the infusion the nurse monitors for signs of hypersensitivity, infection, or infusion reactions and documents vital signs and any adverse events. After completion, the patient is observed per protocol, discharged with post-infusion instructions, and follow-up with the ordering gastroenterologist is arranged for efficacy assessment and ongoing monitoring for infections and immunogenicity. Billing uses J1602 for the drug administered; potential add-on billing includes infusion administration and monitoring codes as clinically appropriate.
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|
96365 | Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour | Commonly used for initial infusion administration and billing when golimumab infusion duration fits this timeframe |
96366 | Intravenous infusion, each additional hour (list separately in conjunction with 96365) | Used for billing additional infusion time beyond the first hour for prolonged administrations
96413 | Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug | Sometimes used by oncology-infused biologic programs where facility billing aligns with chemotherapy infusion codes
36415 | Collection of venous blood by venipuncture | Performed for baseline labs (CBC, CMP, screening tests) before or during biologic therapy
99212 | Office or other outpatient visit for the evaluation and management of an established patient, typically 10 minutes | Used when an E/M visit occurs the same day for evaluation related to infusion; appropriate modifier usage may be needed for bundling
99070 | Supplies and materials (except spectacles), used directly by the patient, unlisted supplies | Used for billing additional supplies specific to infusion that are not included in other codes