Neurology & Pain Management Coding Alert

Boost your E/M -- and reimbursement -- with stellar documentation The Food and Drug Administration approved apomorphine hydrochloride (Apokyn) injection use in 2004, but HCPCS didn't include a code for the drug until 2007. If your neurologist provides Apokyn services for patients with Parkinson's disease, check out our experts- advice on how to code the encounters.
Make the Most of E/M Visits E/M services provide the only opportunity to bill for Apokyn injections, but that doesn't mean you can't get appropriate reimbursement for your physician. Stellar documentation can help justify higher-level E/M codes for these visits when your neurologist provides expanded services. Hang up: Many Medicare carriers won't cover Apokyn because the patient can self-administer the drug. But a physician must evaluate the patient prior to prescribing Apokyn. And the patient will usually receive his first injection in the physician office so the neurologist can evaluate the drug's effectiveness and watch for any side effects, says Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, RCC, CodeRyte Inc. coding analyst and coding review teacher. These visits represent legitimate reimbursable services.
Look to Level 4 or 5 for Evaluation Visit The complexity of the E/M service during which the neurologist considers prescribing Apokyn means that you should report a high-level service (such as 99215, Office or other outpatient visit for the evaluation and management of an established patient ...) for most patients. To claim this service successfully, however, your physician must document his work thoroughly. First steps: To determine whether a patient is a suitable candidate for Apokyn, the neurologist must take a thorough history from the patient, says P. David Charles, MD, associate professor, Movement Disorders Clinic director and neurology residency training program director at Vanderbilt University in Nashville, Tenn. Specifically, the neurologist must determine whether the patient is having -off- episodes that don't respond to medication or other typical treatments, and that truly impact his daily quality of life (muscle stiffness, difficulty starting movement, slow movements). The neurologist must also pay attention to any medication side effects or interactions, as well as any history of cardiac disease or orthostatic hypotension, which requires special caution, Charles says. And the neurologist must determine whether the patient can tolerate the anti-nausea drug trimethobenzamide, which the patient must take for at least three days before the first dose of Apokyn. Details count: The neurologist's documentation should include the additional time required for such a visit, plus the increased levels of history, exam and medical decision-making (MDM).
Initial Injection Calls for Another High-Level E/M Once again, when the patient arrives for his -trial- Apokyn injection -- and if the neurologist documents his effort -- you should report a high-level E/M service. Administering the patient's first dose [...]