Neurology & Pain Management Coding Alert

Question: What is the proper coding for Avonex injections performed in the office? Can I report 99211 for the nurse's time?


Washington Subscriber

Answer: To report an Avonex injection for treating multiple sclerosis (340), claim G0355 (Chemotherapy administration, subcutaneous or intramuscular non-hormonal antineoplastic). The appropriate supply code for Avonex is Q3025 (Injection, interferon beta-1A, 11 mcg for intramuscular use). Because a full dose of Avonex is 33 mcg, you should report three units of Q3025 per full dose administered.

Learn more: For complete information on reporting Avonex injections, see -Avonex Update: Ditch 90782, Reach for G0355 for Injections- in the September 2005 Neurology Coding Alert.

If the neurologist or other provider administers the injection but performs no other services beyond a cursory exam and discussion, you may not report an office visit (99211-99215) in addition to G0355. In this case, the E/M service would not meet the requirement of -significant and separately identifiable- (see -Success With Modifier 25 Is as Easy as 1, 2, 3- in the following article for more information on proper reporting of same-day E/M services with other procedures or services).

If the nurse provides training for the patient, educating him about possible side effects of the drug and how to self-administer, you may report a separate E/M service using 99211 (Office or other outpatient visit for the evaluation and management of an established patient ...). If the nurse provides training on the same day as an injection, be sure to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M service code.