ED Coding and Reimbursement Alert

Question: We are having a problem getting reimbursed for coronary thrombolysis procedures (TNK) - code 92977 - when our ED physician performs them in the emergency room. I've spoken with other coders who've researched the subject and say that carriers won't reimburse for TNK in the ED because they consider it a cardiology service, so the cardiology department is probably billing it after the physician admits the patient. Because our ED physicians usually discuss the case with a cardiologist before they administer drugs, and the ED doctors assume the responsibility while the patient undergoes the procedure, I don't understand why we don't get paid for it.

Virginia Subscriber

Answer: One important detail you need to remember in this situation: A central tenet of CPT is that any qualified physician can bill for any service. In this case, that means billing for tissue plasminogen activator (TPA) is not restricted to cardiologists. So if the ED physicians are the ones supervising the administration of the drug and assuming the risk, they should be billing for it.

TNK is a new single bolus type of TPA that goes in all at once rather than as a drip. Remember when reporting it that your supporting documentation needs to include the indications of the thrombolysis (for example, acute myocardial infarction) and the results following the administration, such as resolution of chest pain. Keep in mind that Medicare does not recognize a professional component to this service.