Neurology & Pain Management Coding Alert

Question: What are the appropriate codes for administering t-PA to the spine (intrathecal) or to the brain (intraventricular)?

Nevada Subscriber

Answer: The Physician Fee Schedule does not assign a physician work value to 37195 (Thrombolysis, cerebral, by intravenous infusion). Experts recommend reporting an appropriate E/M code to receive reimbursement for the t-PA administration. If the initial inpatient or follow-up codes do not apply, use a prolonged service code. Reimbursement for the t-PA service is included in any accompanying E/M service rendered during the same session.

Remember: The CPT prolonged service codes need to be reported in addition to E/M codes when the length of time a physician spends with a patient goes at least 30 minutes beyond what is typical for the service you-re coding for.

How to code for the service: You need to determine which method the provider is using to administer the t-PA:

IV, intra-arterial, intrathecal or intra-ventricular. Also, you need to know if your physician is doing it herself or if she is having a hospital staff member perform the procedure. Look at the following code ranges:

- 62310-62319 for intrathecal injections/catheter infusions

- 61020-61055 for ventricular or cisternal injections.

You also need to know whether the patient has an existing implanted (not external) pump or reservoir that the t-PA is being administered through. Then you should look at 95991 (Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal [intrathecal, epidural] or brain [intraventricular]; administered by physician).

Code 95990 (Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal [intrathecal, epidural] or brain [intraventricular]) is classified as an incident-to code in the Medicare Physician Fee schedule. This means that the indicator "identifies codes that describe services covered incident-to a physician's service when they are provided by auxiliary personnel employed by the physician and working under his or her direct personal supervision. Payment may not be made by carriers for these services when they are provided to hospital inpatients or patients in a hospital outpatient department. Modifiers 26 and TC cannot be used with these codes."

Remember: If your physician orders the t-PA but does not personally refill the implanted intrathecal/ ventricular pump or reservoir on an inpatient, then 95990 would be the appropriate CPT code but will not be reimbursable to the physician.