How would you bill for intranasal med administration with 2 hours of observation?

[acerway]

Hi all - any ideas on how you would bill for this? I just started working for a psych clinic that is using Spravato (esketamine) treatments for depression. The medicine comes in a pre-measured dose. 2 or 3 doses are self-administered intra-nasally at each treatment. It is required for our staff to make sure the patient self-administers correctly, take repeated vital sign readings, and to directly observe the patient for any adverse reactions for a full and constant 2 hours after the first dose is administered. Patients are treated twice a week for the first 4 weeks. Our physician will create the plan of care, but it is sometimes an LPN or MA that will supervise those 2 hours on the subsequent visits. How would you bill if, on some of these treatments, there was no History or Exam documented for an E/M 9921x code to be used, or if the MA was the only one observing? I can't find anything definitive for that type of encounter. That treatment takes up a lot of clinical resources - any suggestions you have are very much appreciated!

 

[mahetol519@gmail.com]

I am actually in the same boat now. We are treating our first patient with Spravato and unsure how this is being billed.

 

[jkyles]

Just a heads up that Medicare will cover administration of Spravato with its own G codes next year.

 

[mitchellde]

Look the new CPT codes for prolonged clinical staff 99415-99416, this should get you what you need for the observation time

 

[lakooms]

Look the new CPT codes for prolonged clinical staff 99415-99416, this should get you what you need for the observation time

I have found that most BCBS do not consider an LPN or RN able to have their time with the patient count towards MD time. What have you found?