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ED 92977, 37195

Taylor Posted Fri 22nd of November, 2019 12:38:56 PM
For the ED MD only, not clinic. Pt was given Tenecteplase IV Push by RN for coronary MI and was flown out to a higher level of care to cath lab. Would appropriate E/M- 25 modifier, cpt 92977 be correct? What if a thrombolytic was given IV to an ED stroke pt? Would E/M-25, cpt 37195 be correct? We believe Medicare does not pay for 92977, 37195, but other payers do. Thanks!
SuperCoder Answered Mon 25th of November, 2019 03:38:14 AM

Hi,

 

As per the CMS guidelines, An intravenous injection or infusion of a thrombolytic agent (e.g., streptokinase) should be submitted with CPT code 92977 when the physician has personally administered it. Monitoring of the patient and associated services should be billed in accordance with the level of medical care reported. CPT codes 37195 and 92977 have a PCTC indicator of a 5 (incident to codes) which identifies codes that describe services covered incident to a physician's service when they are provided by auxiliary personnel employed by the physician and working under his or her direct supervision. Payment may not be made under Part B for these services when they are provided to hospital inpatients or patients in a hospital outpatient department.

 

If a thrombolytic was given IV to an ED stroke pt, E/M-25 and CPT 37195 will  be correct code.

 

Please also check below links for better understanding:

https://www.supercoder.com/coding-newsletters/my-emergency-medicine-coding-alert/reader-question-thrombolytics-article

 

>https://www.cms.gov/medicare-coverage-database/details/article-details.aspx?articleId=55237&ver=20&SearchType=Advanced&CoverageSelection=Local&ArticleType=BC|SAD|RTC|Reg&PolicyType=Both&s=All&CptHcpcsCode=92977&kq=true&bc=IAAAACAAAAAA&

 

If you don’t have access to the link, please let us know.

 

Thanks

 

Taylor Posted Tue 26th of November, 2019 16:26:55 PM
Thank you we just want to be clear. The nurse administered it under the Dr supervision. The nurse and Dr are employed under same employer. We do not bill to Medicare. Can we report CPT 37195 and 92977 to other payers? This is in an ED setting.
SuperCoder Answered Wed 27th of November, 2019 02:27:41 AM

Hi,

Yes, you can report CPT 37195 and 92977 to other payers also. Remember when reporting it that your supporting documentation needs to include the indications of the thrombolysis (for example, acute myocardial infarction) and the results following the administration, such as resolution of chest pain.

 

Thanks

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