tPa Thrombolysis for stroke

sneekersia

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I have just started with Neurology and need help with this. We are being denied when the patient is inpt for this service billing 37195, I assume since this code has not RVU's assigned it is included in the DRG. Is there a S&I code that can be billed in this case?
Thanks
 

Jim Pawloski

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I have just started with Neurology and need help with this. We are being denied when the patient is inpt for this service billing 37195, I assume since this code has not RVU's assigned it is included in the DRG. Is there a S&I code that can be billed in this case?
Thanks
Via SIR code book, 37195 for procedure and 75970 for the s&i codes are used for Infusion for Thrombolysis, cerebral. I wonder if they are not accepting the icd-9 code for the procedure?
 

sneekersia

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37195 for Thrombolysis to eleviate stroke

I don't think that it is the dx code. 37195 is not on the MD fee schedule and has an RVU value of -0-. I am assuming that is because the procedure is infusing the drug thru a catheter, which I suppose can be performed by a nurse and supervised by a physician, which would be included in the DRG for an inpt. If we are infusing thru an existing cath, I presume it would be the S&I code that will be billed. Do you know if that is the correct assumption on my part?
Thanks
Karen
 

Jim Pawloski

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I don't think that it is the dx code. 37195 is not on the MD fee schedule and has an RVU value of -0-. I am assuming that is because the procedure is infusing the drug thru a catheter, which I suppose can be performed by a nurse and supervised by a physician, which would be included in the DRG for an inpt. If we are infusing thru an existing cath, I presume it would be the S&I code that will be billed. Do you know if that is the correct assumption on my part?
Thanks
Karen
I was looking through Code Correct web site and they were stating that the carrier will establish the RVU's and payment for the procedure.
Also, how is the medicine getting into the body? That may make a difference. My experience with thrombolytics is that a catheter is placed into the clot, and then the thrombolytic agent (TPA) is slowly infused into the clot. So you have the catheter placement codes, S&I codes for the diagnostic angiogram, then the interventional codes. The insurance carrier may be thinking that the thrombolytic is I.V. I hope not.

I hope this helps you out,
Jim Pawloski
 

sneekersia

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Thank you, the information you provided is very helpful.
I understand that during the frist three hours the tPa is administered intravenously. If we are between 3-6 hours of the onset a cath is used to direct the agent directly into the clot, but I believe that would be done by the vascular neurosurgeon at our facility and not the neurologist.
I believe most of ours are intravenous, and therefore are included in the DRG. I did see in the Federal Registry that if a TPA is given the DRG assignment is raised a level, which makes sense.
 
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