Neurology & Pain Management Coding Alert

Question: How should I report in-office injections of Avonex for multiple sclerosis patients?

Rhode Island Subscriber

Answer: With the current absence of a national coverage determination, multiple standards for reporting, and recently deleted codes, contacting each individual payer for preauthorization of Avonex will be your best option for proper coding and reimbursement. But you may also be able to use your payer's past performance to deduce its current preferences.
  
Why? HCPCS 2006 deleted G0355 (Chemotherapy administration, subcutaneous or intramuscular non-hormonal antineoplastic). CPT 2006 also does away with 90782, and CMS deleted G0351 (Therapeutic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) as of Jan. 1.
  
Don't be fooled: Avonex is not a chemo drug, but G0355 used to apply because administering Avonex involves similar complexity and resource use as chemo infusions.
 
Also, if the neurologist supplies the Avonex from his own stores, you may charge extra for the cost of the drug supplies. The appropriate code for this is Q3025 (Injection, interferon beta-1A, 11 mcg for intramuscular use). A full dose of Avonex is 33 mcg, so you should report three units of Q3025 per full dose administered.
 
According to the Empire Medicare coverage determination, -HCPCS code J1825 [Injection, interferon beta-1a, 33 mcg] and HCPCS code Q3026 [Injection, interferon beta-1A, 11 mcg for subcutaneous use] are not valid for Medicare use.-
 
Under Medicare guidelines, the neurologist must administer the Avonex personally or incident-to her services and under her direct supervision. -Direct supervision- means that the neurologist must be present in the office area and be immediately available to offer assistance and direction if either is needed during the injection. The neurologist need not, however, be present in the room when the patient receives the injection.