Neurology & Pain Management Coding Alert

Question: We are providing Solu-Medrol to patients in the office. Must the neurologist be present during the administration? If not, what is the correct coding if a nurse administers the medication?

Massachusetts Subscriber
 
Answer: The physician must be present during administration of Solu-Medrol, and his or her presence must be documented in the medical record.
 
Solu-Medrol (methylprednisolone sodium succinate) is a steroid often used to treat symptoms related to multiple sclerosis and, on occasion, migraines. Infusion generally occurs daily for three to five days. To report the service, use 90780 (IV infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour) for the first hour and, if needed, 90781 (... each additional hour, up to eight [8] hours [list separately in addition to code for primary procedure]) for each additional hour. Because 90781 is an add-on code, it should never be billed alone and is modifier -51 (multiple procedures) exempt.
 
The drug may be billed separately with HCPCS code J2920 (injection, methylprednisolone sodium succinate, up to 40 mg) or J2930 (... up to 125 mg), depending on the required dosage.
 
A nurse may administer Solu-Medrol, but the physician must be present in the office suite and immediately available to furnish assistance and direction (i.e., direct supervision) during the infusion. The physician does not need to be present in the room when the procedure is performed. There is no code to report this service if performed by a nurse without physician supervision, and reimbursement will likely be denied if the physician's presence is not clearly noted in the accompanying documentation.
 
Note: A complete explanation of physician supervision requirements may be found in HCFA Memorandum B-01-28 ("Physician Supervision of Diagnostic Tests," change request 850), dated April 19, 2001, and effective July 1, 2001. The memorandum is available on the CMS Web site: www.hcfa.gov.