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Neurology & Pain Management Coding Alert

Reader questions:

Submit E/M, 99354, +99355 for Gilenya

Published on Thu Feb 17, 2011

Question: We're preparing to start offering Gilenya to some of our patients who have relapsing multiple sclerosis. What things should we include in our documentation and preparation?Answer: FDA regulations direct providers to monitor a patient for six hours after the initial dose of Gilenya because of the potential side effect of bradycardia (427.8x, Other specified cardiac dysrhythmias) or AV block (426.1x, Atrioventricular block, other and unspecified). Be sure you have a comfortable place for the patient to spend this time, and that your provider adequately documents any checks.Choose E/M: Because Gilenya is newly approved, some providers still have questions about how to code the service. Review your neurologist's documentation and report the E/M code from 99212-99215 (Office or other outpatient visit for the evaluation and management of an established patient ...) that is supported by the documentation.Add prolonged service: The patient's initial dose potentially qualifies for prolonged service codes because [...]
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