Neurology & Pain Management Coding Alert

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.