Kathleen Posted Fri 29th of September, 2017 07:33:47 AM
What is the correct CPT code to use for the intraventricular administration of Brineura (Cerliponase Alfa)? This is a non-chemo drug administered via a surgically implanted reservoir and catheter to the brain. The drug is typically infused over 4-5 hours.
My thoughts were to possibly CPT 95990 (if administered by RN, depending on scope of practice guidelines/state) or CPT 95991(administered by a physician or other qualified health care professional).
Appreciate your feedback.
SuperCoder Answered Tue 03rd of October, 2017 08:17:30 AM
If the above case is refilling of surgically implanted reservoir and catheter and its maintanence, to the brain with non-chemo drug then we will go for 95990 or 95991.
However, if this is not the case only intraventricular administration via a surgically implanted reservoir and catheter to the brain is done we will bill 96379 (Unlisted therapeutic, prophylactic, or diagnostic intravenous or intra-arterial injection or infusion). Also you should include a cover letter stating why you are using the unlisted procedure code. This separate report should explain, in simple, straightforward language, exactly what the physician did.
Use HCPCS code J3490 or J3590 for Brineura(Cerliponase alfa) along with administration code.
Please feel free to ask for any further query.
Kathleen Posted Thu 05th of October, 2017 12:41:38 PM
CPT 95990/95991 description is, " Refilling and maintenance of implantable pump OR RESERVOIR FOR DRUG DELIVERY, spinal (intrathecal, epidural) or brain (intraventricular), includes electronic analysis of pump, when performed;...
CPT 96379 reflects intravenous or intra-arterial injection or infusion, I question the appropriateness of using this code for an intraventricular administration.
My understanding this procedure is new, so possibly need time for CPT Coding Guidelines to reflect a more precise code.
Your feedback is appreciated.
SuperCoder Answered Fri 06th of October, 2017 09:15:18 AM
we can go for CPT 95990/95991 (Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal (intrathecal, epidural) or brain (intraventricular), includes electronic analysis of pump, when performed). There is no exact code for intraventricular administration but this one is closest to bill. However, since your documentation does not mention maintenance of implantable pump or reservoir for drug delivery you may also use modifier 52 (reduced services). Hope it helps.