Question Esketamine Billing

[jenniferabdelnor]

Recently we had a California payer tell us that we should be using G2082 and G2083 when billing for Spravato visits even though we are not supplying the drug. The patient is obtaining the drug from the pharmacy, bringing it into the office and self administering. We are monitoring the patient for 2 hours as recommended and billing an E/M based on time along with a prolonged service code(99417 or G2212). The Spravato billing guide recommends to bill this way if we are not supplying the medication as well. We are billing this way for all other payers and are having no issues. Has anyone else ran into this issue? Is my interpretation of the G codes correct in that this includes the supply of the medication?

G2082- Office or other outpatient visit for the evaluation and management of an established patient that requires the supervision of a physician or other qualified health care professional and provision of up to 56 mg of esketamine nasal self-administration, includes 2 hours post-administration observation​

 

[talopez]

Yes, your understanding of the coding is correct. The "G" Codes are to be used only when the providers office is supplying the Spravato but I would ask your payor what they are basing this directive on? I have seen one or two payors require the "G" codes regardless of how the medication is obtained but that should be documented in a policy or provider communication of some type. Also, if they are saying this as a result of a documentation audit they could be asking you to do this because the records do not clearly state that the patient obtained the drug from an outside pharmacy. Hope this helps

 

[jkyles]

I'm confused. A patient can't purchase Spravato from a pharmacy. https://www.spravato.com/patient-education/

You cannot take SPRAVATO® on your own. You will administer SPRAVATO® nasal spray yourself under the supervision of a healthcare provider, at a certified SPRAVATO® treatment center. You can choose the location that works best for you; ask your healthcare provider to help find a location. SPRAVATO® cannot be purchased at a pharmacy. Because of the risks for sedation or loss of consciousness, dissociation, respiratory depression, and abuse and misuse, SPRAVATO® can only be administered at healthcare settings certified in the SPRAVATO® Risk Evaluation and Mitigation Strategy (REMS) Program.