Neurology & Pain Management Coding Alert

Question: Since Medicare has assigned a physician work value to tissue plasminogen activator for 37195 we are having trouble getting reimbursed for the E/M code. We used modifier 57 on the E/M code, but the payer denied 31795 stating it was included in the E/M service. We also tried modifier 25. Medicare denied that because of an improper place of service: inpatient at hospital facility. How can we report this service so that we get paid for the TPA? Missouri Subscriber Answer: Medicare will not pay your neurologist for the tissue plasminogen activator (TPA) infusion in the facility setting. According to the Medicare Physician Fee Schedule,37195 (Thrombolysis, cerebral, by intravenous infusion) does not have an established relative value unit (RVU) valuation including no established work RVU. Medicare considers the code to be "carrier priced." There are no Correct Coding Initiative (CCI) edits bundling E/M codes with 37195. Also, 37195 is [...]