Neurology & Pain Management Coding Alert

Question: What is the appropriate way to bill for tPA? Can we bill for tPA on the same day as an E/M service such as critical care?

West Virginia Subscriber

Answer: Your question shows a complex coding scenario for two reasons:

- You can bill both services because the critical care codes do not include tPA. Be cautious, however, because the time your physician spends in tPA services is not part of the critical care time. You could find yourself double-billing for the same time if you-re not careful.

- If the critical care service is truly separate from the tPA procedure and its time, your physician's documentation must be impeccable to identify both components of the care. Your physician should document his start and stop times for tPA and the critical care service. Remember the critical care time must be greater than 30 minutes. Documentation should also clearly show the critical care service/intervention taken and the reasons for it.

If you do have a situation that merits coding both services, submit the tPA service with 37195 (Thrombolysis, cerebral, by intravenous infusion). Base your critical care code on the amount of time your physician spent on the service with either 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) or +99292 (- each additional 30 minutes [list separately in addition to code for primary service]).

Final note: Code 37195 is a carrier-priced code, so RBRVS does not list RVUs for the service. Check with your carrier for its valuation/allowable amount.