Correct Coding Strategies to Get Paid for Administration and Monitoring of Thrombolytics
Published on Thu Jul 01, 1999
The use of a group of drugs known as thrombolytics (tPA, Streptokinase, Retivase, etc.) are some of an ED physicians most powerful weapons in treating patients who present in the middle of acute myocardial infarctions (MI) or shortly after suffering a stroke.
However, coders are often confused about the correct way to report the administration of thrombolytics in the emergency department. Different codes are used depending on the site of action for which the drug is intended, and Medicare does not recognize the physician work component involved, making reimbursement even more tricky.
Due to varying payer coverage policies, reimbursement for thrombolytic administration is almost always going to be complicated, advises John Turner, MD, medical director for documentation and compliance at TeamHealth, Inc., an emergency medicine staffing company based in Knoxville, TN, and a member of the American College of Emergency Physicians Coding and Nomenclature Advisory Committee.
However, there are some keys to correctly reporting the use of thrombolytics and to maximize the reimbursement for this service.
Clinical Background
Thrombolytics are clot-dissolving drugs administered intravenously to halt damage to the coronary arteries from an MI. A few years ago, doctors also discovered that intravenous infusion of one type of thrombolytic within a short time of the onset of symptoms helped to drastically reduce the long-term damage from cerebral infarcts (stroke).
While the drugs can be life-saving, in order to be useful they must often be administered as soon as possible after the onset of symptoms. They also carry the risk of significant side effects in some situations. In most cases, the drug is administered through a continuous infusion with the physician monitoring the patient for signs of adverse reaction until a specialist assumes care, says Turner.
Optimize Pay-up with Correct Codes
According to CPT, code 37195 (thrombolysis, cerebral; by intravenous infusion) should be used when thrombolytics are administered to treat stroke patients, and CPT 92977 (thrombolysis, coronary; by intravenous infusion) when the patient is treated for an MI, says Danelle Kelly, RN, CPC, CPC-H, a coding consultant with D. J. Kelly & Associates, Inc., an emergency medicine and hospital billing consulting firm in Schaumburg, IL.
Some readers have asked whether the code 37201 (transcatheter therapy, infusion for thrombolysis other than coronary) would be appropriate for use in reporting physician administration and monitoring of tPA infusions for MI patients.
Note: Code 37201 has a Medicare relative value unit (RVU) of 10.70 and a physician work component of 5.00.
But, emphasizes Kelly, this code [37201] indicates it should not be used for coronary treatment.
Again, she recommends the 37195 code rather than 37201 for cerebral infusions because 37195 specifically states cerebral, by intravenous infusion.
The concentration used for coronary arteries is totally different than [...]
