Neurology & Pain Management Coding Alert

Question: I was told by our Avonex representative that I should be billing the chemo administration code 96401 along with Q3025. Are these the correct codes for administrating Avonex?

Nebraska Subscriber

Answer: Avonex is an interferon, a biological response modifier, used to treat patients with relapsing forms of multiple sclerosis.  You are correct to use 96401 (Chemotherapy administration, subcutaneous or intramuscular; non-hormonal anti-neoplastic) even though Avonex is not a chemotherapy drug. Due to the complexity of biological response modifier administration, injecting Avonex intramuscularly involves similar complexity and resources as chemotherapy administration. The CPT section guidelines for Chemotherapy Administration state codes 96401-96549 apply to parenteral administration of non-radionuclide anti-neoplastic drugs; and also to anti-neoplastic agents provided for treatment of noncancer diagnoses or to substances such as certain monoclonal antibody agents, and other biologic response modifiers.

Dont miss this: Under Medicare guidelines, your neurologist must administer the Avonex personally or incident to her services and under her direct supervision. Direct supervision means your neurologist must be present in the immediate area and be instantly available to offer assistance and direction during the injection. However, your neurologist doesnt need to be present in the room when the patient receives the injection.
When your neurologist administers the IM injection in the office and uses Avonex from the office supply, he may also report a HCPCS code to be reimbursed for the drug.

The HCPCS book contains two codes for the intramuscular injection of Avonex: J1825 (Injection, interferon beta-1A, 33 mcg) and Q3025 (Injection, interferon beta-1A, 11 mcg, for intramuscular use). Though many payers may accept either J1825 or Q3025 for Avonex, Medicare currently classifies J1825 with an I status indicator or Not valid for Medicare purposes. Interferon beta-1A is typically classified as a self-administered drug, so Q3025 is the correct code for billing Medicare for Avonex administered by your provider. Report three units of service of Q3025 if your provider injects the typical 30 mcg dose of Avonex.