Pulmonology Coding Alert

Question: When we report TPA infusions with an unlisted procedure, what code should we compare 90779 to for payment purposes?

California Subscriber Answer: Experts generally recommend that when filing an unlisted-procedure code you provide a complete description of the service and relate the charge to an existing procedure. For instance, you could equate 90779 (Unlisted therapeutic, prophylactic or diagnostic intravenous or intra-arterial injection or infusion) for tissue plasminogen activator (TPA) infusions to 90765 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; initial, up to 1 hour).

Code 90765 contains 2.00 transitional total nonfacility relative value units using the 2007 Medicare Physician Fee Schedule or pays a national rate of $75.80 (2.00 RVUs x 2007 conversion factor of 37.8975).

Compare additional hours of infusion to units of +90766 (... each additional hour [list separately in addition to code for primary procedure]), which has 0.66 RVUs or pays an unadjusted rate of $25.01. Attach an invoice showing the actual cost of the TPA used on that occasion.

Also: Bill only for TPA initiated in a physician's private office. In a hospital or emergency department, the "facility" reports the service.