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Derm-Propranilol for Hemagioma tx billing

  1. Default Derm-Propranilol for Hemagioma tx billing
    Medical Coding Books
    Dermatologist in Office POS is using Propranilol for treatment of Hemangioma. How would I bill if patient is in the office for many hours however the only E/M service going on is blood pressure checks/vital signs. I am considering using the unlisted derm procedure code but maybe it should be a E/M level of service. I don't think using time is necessarily correct because doctor isn't coordinating care/consulting with patient. Any feedback would be Greatly appreciated!! Thanks.

  2. Default
    Our docs do not use Propranolol. Are they injecting this into the hemangioma? If so, I would code 11900 and the code for propranolol.

    Why is the patient in the office for hours? If the doctor documents that he/she is counseling the patient on the condition, reviewing the options of treatment, discussing the side effects of Propranolol, etc then consider time based billing---however, the doctor has to spend face-to-face time with the patient. If the patient receives an injection then they wait in the lobby to make sure the treatment worked or that there is not an allergic reaction then that wait time isn't face-to-face.

  3. #3
    Milwaukee, WI
    Default Any Answers re:Propranolol?
    Hi, I am looking for more info on this too. Propranolol isn't injected into the hemangioma, it is taken orally. It is a drug with a risk of possible severe cardiac and glycemic side effects, therefore the patient must be closely monitored for several hours after it is given. In fact, in the Aetna medical policy, it indicates that an inpatient stay of up to 2 days may be approved for this purpose. At our facility, the infant is usually given a half strenght dose on the first visit and monitored for several hours. If no side effects s/he is sent home. Several weeks later, s/he comes back for a full strength dose and is again monitored for several hours. If all is good, then the parents continue with the medication administration at home for up to a year, with regularly scheduled visits. The question is how to bill for this. The lesion removal/injection codes are not appropriate. I don't believe the destruction ones really fit well either. E&M/prolonged may be the most appropriate, documentation is key. I'd like to know what others are doing for this. Any feedback would be great!


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