Neurology & Pain Management Coding Alert

Although the descriptors for G0359 and G0360 specify "chemotherapy administration," these are nevertheless the correct codes for Tysabri under Medicare guidelines in 2005.

CMS transmittal 129, dated Dec. 10, 2004, and effective Jan. 1, 2005, specifies, "Under the new codes, chemotherapy administration codes will apply to parenteral administration of nonradionuclide anti-neoplastic drugs and also antineoplastic agents provided for the treatment of noncancer diagnoses (e.g., cyclophosphamide for autoimmune conditions), or to substances such as monoclonal antibody agents and other biologic response modifiers [which includes Tysabri]."

In other words: Although the codes say "chemotherapy," they apply to intravenous infusions of monoclonal antibodies because these infusions have similar complexity and resource use as chemotherapy infusions, says Anne M. Dunne, RN, MBA, MSCN, administrator for the Comprehensive Multiple Sclerosis Care Clinic at South Shore Neurologic Associates PC in Patchogue, N.Y. She cites Medicare's "Revisions to Payment Policies Under the Physician Fee Schedule for Calendar Year 2005," released last November.