Neurology & Pain Management Coding Alert

37195 isn't enough for payment Unless your neurologist wants to give her services away, you shouldn't report 37195 (Thrombolysis, cerebral, by intravenous infusion) by itself. Rather, you must always pair the t-PA administration code with an appropriate E/M service code.
 
The most recent Physician Fee Schedule assigns 8.08 relative value units (RVUs) to 37195. However, none of these RVUs are designated for "physician work."
 
Translation: In other words, payment for 37195 only covers the facility's expense in providing administration of t-PA. There's no money to pay the neurologist for his effort. Nevertheless, the physician must spend considerable time evaluating a potential t-PA patient, and the risk associated with t-PA administration is very high.
 
"Patients being considered for t-PA are certainly unstable. They are within the first three hours of onset of a moderate-to-severe stroke," says Jeff Saver, MD, professor of neurology at Geffen School of Medicine at UCLA and neurology director of the UCLA Stroke Center in Los Angeles. "These patients have a 21 percent risk of fatal outcome if untreated." Choose Your E/M Category(ies)  To receive payment for the physician's effort when treating a t-PA patient, you may choose from among four E/M code categories, according to the American Academy of Neurology (AAN):

  critical care services (99291-99292)
  prolonged care services (99356-99357)
  initial inpatient care (99221-99223)
  initial and follow-up consultation codes (99251- 99255, 99261-99263). Look to critical care first: The code category you choose depends on individual circumstances, but critical care codes are a good place to begin.
 
CPT requirements for critical care are strict, but patients requiring t-PA will almost always qualify.
 
"Making the decision to give t-PA is an element of critical care medicine," Saver says. In trials, "t-PA was associated with a symptomatic hemorrhage rate of 6.4 percent. Thus, about one in 17 patients who receive t-PA will have some degree of brain hemorrhage associated with some degree of worsening," he continues. "Only 38 percent of patients will achieve a good functional outcome if untreated. They are at risk for brain hemorrhage, seizure, cerebral herniation, pneumonia, pulmonary embolism, and numerous other acute neuromedical complications."

What is t-PA? Tissue plasminogen activator, more commonly known as t-PA, helps to dissolve blood clots and restore blood flow. When taken intravenously, the drug has been shown to decrease the chances of debilitating injury and neurological damage for stroke victims if administered within three hours of the stroke episode.
 
Because the drug is an anticoagulant, providing t-PA to a patient with bleeding in the brain can cause a fatal hemorrhage. Therefore, the neurologist must order a computed tomography scan of the head prior to giving the medication to be sure the patient doesn't have intra-cranial bleeding.

Note the Time Precisely for Critical Care The key to reporting critical [...]