Neurology & Pain Management Coding Alert

Question: Our neurologist has decided to start administering Depacon and Keppra infusions in our office. What will be the correct way to code these treatments?

Maine Subscriber 

Answer: Coding drug administration requires knowing the administration method (you list both as IV infusions) and timing (start and stop times should be documented). The specific drug administered is also important. 

Example: If the patient receives a 60-minute Depacon infusion and a 15-minute IV push of Keppra, you should look at reporting:

• 96365 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; initial, up to 1 hour) for the 60-minute infusion
• +96375 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; each additional sequential intravenous push of a new substance/drug [List separately in addition to code for primary procedure]) for the IV push.

Review the infusion CPT^® section guidelines for information on how to choose the initial and sequential codes (the order given is not the deciding factor) and understanding time requirements (such as one definition of an intravenous or intra-arterial “push” is an infusion of 15 minutes or less).

If your practice bears the cost of the drugs, you’ll also want to bill for those. Appropriate choices would be J3490 (Unclassified drug) for Depacon and J1953 (Injection, Levetiracetam, 10 mg) for Keppra. Be sure to follow the payer’s rules on supporting documentation for J3490 and report a maximum of 1 unit of service. You can often report multiple units of service for J1953, with common dosages starting at 500 mg but sometimes ranging higher.

Final note: You’ll also want to check to see whether the payer has specific diagnosis/medical necessity requirements for coverage of the IV versions of these drugs (as opposed to oral).