Neurology & Pain Management Coding Alert

Question: My physician wants to teach his patients how to give themselves Imitrex injections. We will get the medication from the pharmaceutical reps. Do I bill for the injection, or will I bill an office visit for the teaching?

Pennsylvania Subscriber

Answer:Since the patients will give themselves the injections, you'll focus on the teaching. How you report the service depends on the actual instruction and who provides the education.

At first glance, your best option might be 98960 (Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient [could include caregiver/family] each 30 minutes; individual patient).

Caveat: The key to reporting 98960 is that it must be a standard, established curriculum recognized by a professional society or organization. Training patients to administer Imitrex might not qualify for 98960 because of the criteria involved.

Other options: A nurse, non-physician practitioner (NPP), or physician might instruct the patient. If the patient comes to your office only for instruction by a nurse, report 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician. Usually, the presenting problem[s] are minimal. Typically, 5 minutes are spent performing or supervising these services). If the physician or NPP instructs the patient during an office visit, the appropriate E/M service code includes the education. The same holds true if the physician sees the patient, prescribes the Imitrex and education during the visit, and the nurse provides the instruction "the E/ M code includes everything.

When selecting the E/M code, choose the appropriate option from 99211-99215 (Office or other outpatient visit for the evaluation and management of an established patient ...). Remember that the time spent counseling can help determine the E/M code level if the physician or NPP spends 50 percent or more of the time training the patient and counseling on the appropriate use of the medication.

Example: A patient comes to your office for a follow-up visit. The physician spends 45 minutes with the patient (15 minutes taking the patient's history and discussing prognosis and a plan of care including Imitrex administration; 30 minutes on a detailed explanation of how and when to use the medication and showing the patient the correct injection technique). Because the physician spent more than half the time on training and instruction, you could report the higher-level E/M code 99215.

Physicians can prescribe Imitrex for patients who have acute migraines.