ED Coding and Reimbursement Alert

Thrombolytics, with open blocked vasculature, have been used in the emergency department for years to treat patients with specific heart conditions. More recently, these medications are being administered to stroke patients to relieve immediate symptoms, minimize damage and reduce long-term effects. With either the more conventional or the emerging application of this therapy, reimbursement is not assured. Coders play a significant role in the payment process by learning the appropriate codes to assign and by understanding which alternative codes might be accepted if the initial claim is rejected by payers. Reporting Coronary Thrombolysis Individuals presenting to the ED with symptoms of acute myocardial infarction (MI) (e.g., 410.01, Acute myocardial infarction, of anterolateral wall; initial episode of care) might be treated with coronary thrombolysis. ED physicians regard this therapy as the clinical standard of care and order the administration of a thrombolytic agent to open any vascular occlusions interfering with the cardiac function. While CPT provides only two codes (92975, 92977) that describe this type of therapy, they are often misused or interchanged, says John Turner, MD, FACEP, medical director for coding and documentation at TeamHealth Inc. in Knoxville, Tenn.

The first of these codes listed in CPT is 92975 (Thrombolysis, coronary; by intracoronary infusion, including selective coronary angiography). "Because the first words in the definition are thrombolysis and coronary, coders are quick to assign 92975. It is confusing," Turner says. "However, this is incorrect because the remainder of the definition makes it clear that 92975 is a surgical procedure. Intracoronary infusion is administered directly through the coronary artery, which requires the physician to thread a catheter from the femoral artery through the vascular system up to the coronary artery. This procedure is not conducted in the ED."

Instead, he says, coders must look beyond the first code and assign 92977 ( by intravenous infusion). "This is the code used to report thrombolysis when the physician orders a large IV and has the medication delivered as a bolus." Single Code Describes Cerebral Thrombolysis Turner notes that when cerebral thrombolytic agents are administered to stroke patients (e.g., 436, Acute, but ill-defined, cerebrovascular disease), coders assign 37195 (Thrombolysis, cerebral, by intravenous infusion). This service is provided less frequently than coronary thrombolysis because its value is still being debated. "Neurologists dont agree on the effectiveness of cerebral thrombosis," Turner says.

Before cerebral thrombolysis is even considered as a treatment option, he says, a number of diagnostic studies must be done quickly, including a physical exam, blood work, and a CT scan (e.g., 70460, Computerized axial tomography, head or brain; with contrast material[s]) to rule out intracranial bleeds. Among the conditions that cause a stroke are hemorrhages, blood clots or obstructions caused by plaque buildup. [...]