Neurology & Pain Management Coding Alert

Neurology practices debating the pros and cons of providing services to patients needing Solu-Medrol infusion should examine related coding and billing issues carefully. In many instances, there may be a significant discrepancy between costs and reimbursement levels. But by billing for all services associated with the infusion, neurology practices may find it beneficial both to themselves and their patients.

Solu-Medrol is the brand name for methylprednisolone sodium succinate, a steroid most commonly used to treat acute symptoms related to multiple sclerosis (340) and less frequently for migraines (346.0-346.9). It is typically delivered in a hospital outpatient setting to patients experiencing an exacerbation of symptoms. The steroid is infused daily for three to five days.

In recent years, a growing number of home-health agencies have been offering infusion services to their patients. To increase revenue to their own private practices, some neurologists have begun to consider similar services that include infusing Solu-Medrol in their offices.

Coding Solu-Medrol Infusion

Code 90780 (IV infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour) is assigned for the medical services provided during delivery of Solu-Medrol. Add-on code 90781 (each additional hour, up to eight [8] hours [list separately in addition to code for primary procedure]) may be assigned for extended services.

But these codes need to be assigned with caution, warns Cindy Parman, CPC, CPC-H, co-owner of Coding Strategies Inc, an Atlanta-based coding and reimbursement firm that supports 1,350 physicians. Physicians and coders need to remember that documentation of physician presence during the infusion is critical, she says. These codes should not be billed if the patient is in a room receiving infusion services monitored by a nurse, while the physician is treating other patients.

Physicians providing Solu-Medrol in the office also may assign 36415 (routine venipuncture or finger/heel/ear stick for collection of specimen[s]) if blood is drawn for lab work prior to the infusion.

Should We Provide This Service?

Physicians affiliated with the department of neurology at the University of Maryland Medical Center, which includes 40 neurologists and 15 residents, recently considered providing Solu-Medrol infusion services in its offices, according to Senior Administrator Bryan Soronson.

We observed how the home agencies were providing the drug in the home and saw it as an opportunity. We believed there were significant advantages to the patient to be treated in an office setting, he explains. The clinical setting allows medical personnel to observe how well patients respond to the Solu-Medrol and helps ensure they administer the drug correctly.

Before the neurology practice launched this new service, however, Soronson adds, it conducted a thorough cost analysis. The process, unfortunately, highlighted some complications that indicated it could be a risky business.

Costs May Hinder Neurology Practices

Soronsons research indicated that the central risk factors were in acquiring the steroid at a reasonable cost and achieving reimbursement rates to cover the direct and indirect costs of delivering the infusion services.

Depending on the dosage required, one of two J-codes may be assigned to Solu-Medrol:

J2920injection, methylprednisolone sodium succinate, up to 40 mg; Solu-Medrol; and

J2930injection, methylprednisolone sodium succinate, up to 125 mg.

A significant factor in buying and supplying the steroid lies in the volume the buyer orders from the manufacturer, notes Joji Valino, RN, BSN, clinical coordinator for the Neurology Clinic with the University of Maryland Medical System, who assisted Soronson in his cost analysis.

This is where hospitals have a great advantage, she points out. They are able to provide the infusion services to a greater number of patients than a single practice can, which means they can purchase larger volumes of the drug and negotiate a better price. A hospital may be able to buy Solu-Medrol at the equivalent of wholesale prices, for instance, while a private practice may have to pay retail.

Soronson adds that the price of a drug like Solu-Medrol also is affected by market factors. For instance, when we were investigating the viability of providing Solu-Medrol infusion in our offices, we also looked into availability of other drugs administered by infusion. In some cases, there was a shortage. So, prices for those medications were up. Smaller organizations just arent able to absorb those differencesespecially when our reimbursement levels remain constant. We factored in the possibility of this happening with Solu-Medrol, which was discouraging.

Scrutinize Reimbursement Rates Closely

Reimbursement levels are the second half of the equation for private practices to consider, Valino stresses. Reimbursement rates can differ from state to state, and between carriers, she says. This will clearly have an impact on the viability of providing Solu-Medrol in an office setting. For instance, the hospital here at the University of Maryland receives state funding to treat the indigent who suffer from multiple sclerosis. The reimbursement levels received from this agreement allow us to receive payment in situations where a private practice might not.

Other coding and billing factors affect the feasibility of offering office-based Solu-Medrol infusion as well. You need to look at what specific charges are assigned to the services codes and compare these to your staffing and facilities requirements, advises Soronson.