Neurology & Pain Management Coding Alert

Reader Questions:

96415 Doesn't Count Toward Observation

Question: Our physician administered a one-hour infusion of Tysabri, followed by one hour of observation. Can I report 96415 for the hour of observation, in addition to the infusion code? North Carolina Subscriber Answer: Look to 96413 (Chemotherapy administration, intravenous infusion technique; up to one hour, single or initial substance/drug) for the infusion. A parenthetical note with +96415 (... each additional hour [list separately in addition to code for primary procedure]) states, "Report 96415 for infusion intervals of greater than 30 minutes beyond one-hour increments." These instructions clarify that 96415 represents additional hours of infusion, not observation time -- which means you should not report it with your case in question. Complete your claim by submitting J2323 (Injection, natalizumab, 1 mg) for the Tysabri. Observation question: Coders sometimes ask if they should also report their physician's observation time in this situation. The codes for prolonged services may be tempting, but you should add these only to other E/M service codes. Because CPT doesn't include other codes appropriate for observation services, you-ll probably have to write off the time your physician spent in observation.
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in Revenue Cycle Insider
  • 6 annual AAPC-approved CEUs
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more

Other Articles in this issue of

Neurology & Pain Management Coding Alert

View All