Neurology & Pain Management Coding Alert

Question: We are having difficulty getting paid by Medicare carriers for initial injections of Apokyn. How should we report this service?


Hawaii Subscriber


Answer: High-level E/M codes are going to be your primary way to report the extensive time and effort that can go into Apokyn administration. If the neurologist or nurse injects Apokyn, you can also claim an injection code. But if the patient self-administers the drug, Medicare will not pay separately for this service.   

Update: Before January 1, use 90782 (Therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular) for injection. But you need to change to using 90772 with CPT 2006.
 
With proper documentation, you will likely be able to code this visit with established patient code 99214 or 99215 (Office or other outpatient visit for the evaluation and management of an established patient-). Initial or -trial- Apokyn injections often contain the following elements, all of which can help to support a higher-level E/M:

- Establishing that the patient is in the -off- or immobilized state

- Evaluating patient's tolerance of anti-nausea drugs

- Re-evaluating concomitant medications that can affect blood pressure or orthostatic responses

- Completing a review of systems (ROS) that records lack of chest pain and syncope

- The decision to prescribe Apokyn or schedule another trial.