Neurology & Pain Management Coding Alert

Question: Our neurologist administered Cytoxan and Solu-Medrol injections to a patient on the same day (but at different times). We reported 96413 and 90765 for the procedures, but the carrier denied it as not being separately payable. We thought National Correct Coding Initiative edits approved reporting 90765 with modifier 59 (Distinct procedural service). What should we do?


Indiana Subscriber


Answer: You reported the correct codes with 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug) for Cytoxan and 90765 (Intravenous infusion, for therapy, prophylaxis or diagnosis [specify substance or drug]; initial, up to 1 hour) for the Solu-Medrol (assuming those codes represent the correct timeframes).
 
Your physician administered two drugs, so you should be able to code for both. Report the appropriate choice from J9070-J9097 for the Cytoxan and either J2920 (Injection, methylprednisolone sodium succinate, up to 40 mg) or J2930 (Injection, methylprednisolone sodium succinate, up to 125 mg) for the Solu-Medrol.

Ask your carrier to explain the denial so you can refile the claim and know how to report it next time.