Neurology & Pain Management Coding Alert

Question: How should I report Avonex injections done in the office for Medicare patients? Should I bill 99211 for the nurse's time?

North Carolina Subscriber

Answer: To report an Avonex injection for treating multiple sclerosis, bill 90782 (Therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular]). The appropriate supply code is J1825 (Injection, interferon beta-1a, 33 mcg).

If the physician or other provider administers the injection but perform no other services beyond a cursory exam and discussion, you may not report an office visit (99211-99215) in addition to 90782. According to Medicare guidelines, all procedures include an inherent E/M component. If the physician provides a significant, separately identifiable E/M service for a new patient complaint (including a change in status of any current conditions), you may report an office visit or other E/M service (as appropriate) with modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended. Note that most payers do not consider a level-one or -two E/M service (for instance, 99211, 99212) "significant."

In some cases, the physician or nurse may provide training for the patient, educating him or her about possible side effects of the drug and how to self-administer. In such cases, a separate E/M service (probably using time as the key component) is warranted.