Neurology & Pain Management Coding Alert

Don't miss out on $40 per 96415 service You need a solid understanding of how to code for Tysabri services to avoid missing out on the maximum payments you deserve -- especially if you-re still coming to grips with CPT infusion codes. Learn from our experts as they offer you some essential rules to determine which codes to report for administering Tysabri, and you-ll be reaping the reimbursement benefits. Rule 1: Know Your Coding Specifics HCPCS: Neurologists typically use Tysabri to treat and reduce the frequency of clinical relapses of multiple sclerosis. Also known by the generic name natalizumab (and formerly called Antegren), it is associated with treatment of multiple sclerosis exacerbations. The correct code for the Tysabri drug is J2323 (Injection, natalizumab, per 1 mg). Note: HCPCS 2008 replaced Tysabri's temporary Q code with this J code, going into effect on Jan. 1. ICD-9: Your primary ICD-9 code will most likely be 340 (Multiple sclerosis), representing a diagnosis of MS. Patients with MS have an 85 percent chance of relapse at the onset, says Howard S. Rossman, DO, FACN, medical director of the MS center of the Michigan Institute for Neurological Disorders (MIND) and clinical professor of neurology at Michigan State University in his presentation, "Setting Up Neurology-Based Infusion Capabilities -- Behind the Rationale and Decision-Making Process" (http://www.mscare.org/cmsc/images/pdf/2005CMSC_Workshop15_allauthors.pdf). CPT: Typically, the patient receives the drug via intravenous infusion every four weeks in either the inpatient or the outpatient setting. You should code the infusions with 96413 (Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug) and possibly the add-on code +96415 (- each additional hour [list separately in addition to code for primary procedure]). Here's why: Although 96413 and 96415 specify "chemotherapy administration," the codes also apply to infusions of "monoclonal antibody agents and other biologic response modifiers" -- and Tysabri falls into this category, says Linda Parks, MA, CPC, CMC, CMSCS, an independent coding consultant in Atlanta. Resource: According to the CPT chemotherapy administration section guidelines, "Chemotherapy administration codes 96401-96549 apply to parenteral administration of non-radionuclide anti-neoplastic drugs, and also to anti-neoplastic agents provided for treatment of noncancer diagnoses (e.g., cyclophosphamide for auto-immune conditions) or to substances such as monoclonal antibody agents, and other biologic response modifiers." Rule 2: Watch the Clock -- Keep Track of Time To ensure you-re receiving the maximum allowable reimbursement for a Tysabri infusion, noting exactly how long an infusion lasts is absolutely necessary. Protect yourself: Make sure your neurologist accurately documents the start and stop time in the chart. The rule: You-ll find parenthetical notes with 96415 stating, "Report 96415 for infusion intervals of greater than 30 minutes beyond one-hour increments." That means you shouldn't report 96415 [...]