Neurology & Pain Management Coding Alert

Question: How should I bill for administration of IV Solu-medrol in the office?

Virginia Subscriber

Answer: Solu-Medrol is the brand name for methyl-prednisolone sodium succinate, a steroid used to treat symptoms related to multiple sclerosis and other disorders. To report the service in the office, use 90780 (IV infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour) for the first hour and, if needed, +90781 (... each additional hour, up to eight [8] hours [list separately in addition to code for primary procedure]) for each additional hour. Code 90781 is a modifier -51 (Multiple procedures) exempt add-on code that you should never bill alone. You may also report 36000* (Introduction of needle or intracatheter, vein) for insertion of the IV and 36415* (Collection of venous blood by venipuncture) if the physician draws blood for lab work prior to the infusion.

A nurse may administer Solu-Medrol, but the physician must be present in the office suite and immediately available to furnish assistance and direction (that is, direct supervision) during the infusion, and his or her presence must be documented in the medical record. The physician does not need to be present in the same room when the nurse performs the procedure, however.

Bill for the drug separately using HCPCS code J2920 (Injection, methylprednisolone sodium succinate, up to 40 mg) or J2930 (... up to 125 mg), depending on the dosage.

Do not report an E/M code in addition to the infusion codes (90780/90781) unless the physician provides a significant, separately identifiable E/M service at the same time (that is, do not charge a separate E/M if the purpose of the visit is the infusion only). If E/M is separate, be sure to append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to that code.