Case Study:
Increase Reimbursement for Blood-brain Barrier Disruption Therapy
Published on Sun Oct 01, 2000
When billing for blood-brain barrier disruption therapy (BBBD) to treat brain tumors, neurosurgeons often have difficulty getting fully reimbursed. But through proper diagnosis, treatment and coding, and meeting with carriers to explain the effectiveness of treatment and how it has less cognitive side effects than radiation treatment, neurosurgeons should greatly increase payment for their services.
The following case study and coding procedures were provided by Helen Kleffner, billing specialist for Edward A. Neuwelt, MD, department of neurology and neurosurgery, Oregon Health Sciences University, who pioneered BBBD therapy, in Portland, Ore.
Case Description
A 28-year-old male with a brief history of headaches (784.0) and focal seizures (345.50) is diagnosed with central nervous system (CNS) lymphoma (192.9 or 198.4). The patient is given an overview of treatment options and decides to have BBBD therapy because of the decreased risk of cognitive damage as compared to radiation therapy, as well as the increased length of survival as compared to other treatment methods.
Treatment Explanation
For a patient diagnosed with a brain tumor, one of the treatment problems is that radiation to the brain may cause severe cognitive damage. Chemotherapy drugs are often used for treating chemosensitive tumors, but the brain has a natural protective barrier composed of tightly knit endothelial cells lining the walls of the brains blood vessels (the blood-brain barrier), which prevents the chemotherapeutic drugs from penetrating into the brain to destroy the tumor. BBBD therapy breaks down this barrier to allow chemotherapeutic drugs into the brain to kill the tumor cells. Radiographic review of the patients CT brain scan to assess the extent of tumor and associated mass effect, prior to BBBD, is important to ensure the patients eligibility for this treatment.
Conducting the Procedure
The patient is usually in the hospital for four days. On the first day, the patient goes to the pre-admission testing clinic where the BBBD nurse practitioner performs a complete history and physical examination, orders laboratory tests, requests a CT or a magnetic resonance imaging (MRI) of the head, and schedules an anesthesia evaluation. Neuropsychological testing is also performed by a psychologist to establish a cognitive baseline before treatment. The patient is then admitted to the oncology ward of the hospital.
On the second and third days, the patient undergoes BBBD treatment with chemotherapy. BBBD is an angiographic procedure (a process that involves intra-arterial catheterization and x-ray pictures of the blood vessels). While the patient is asleep under general anesthesia, a catheter is inserted into the femoral artery, just above the hip, and it is advanced into one of the neck arteries. An infusion of a concentrated sugar solution (mannitol) is sent through the catheter to open the blood-brain barrier temporarily. Immediately after the [...]
