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TPA for stroke

Desirae Posted Fri 24th of January, 2020 17:08:44 PM
Patient was seen in our ER, given TPA for stroke and transferred to a more advanced hospital. How should the TPA administration and infusion be coded for the Facility and Professional services? The ER doctor is not employed by the hospital. Would the facility code critical care, 37195 and 96365 for another IV medication running concurrently? The physician only documented "patient received thrombolytic within ED" is that sufficient? He ordered TPA but the ER nurse administered - would I code Thrombolysis for his professional services (granted there's enough documentation to support) along with critical care? This is really confusing to me. Thank you in advance for your prompt response.
SuperCoder Answered Mon 27th of January, 2020 03:31:37 AM

Hi Desirae,


As per AMA guidelines, when the patient is admitted to the hospital as an inpatient in the course of an encounter in another site of service (eg, hospital emergency department, observation status in a hospital, office, nursing facility) all evaluation and management services provided by that physician in conjunction with that admission are considered part of the initial hospital care when performed on the same date as the admission. The inpatient care level of service reported by the admitting physician should include the services related to the admission he/she provided in the other sites of service as well as in the inpatient setting.


However, if the patient has been admitted to some other hospital, then the ER physician should bill for the rendered services under his NPI number. Facility would charge for the technical component of the services rendered to the patient till the patient was transferred to different location.


Drug administration through IV route should be properly documented. Separately documented infusion note should mention the start time and end time of infusion along with details of the drug administered (quality, quantity, type of infusion and other information). If your provider note mentions "patient received thrombolytic within ED”, provided documentation would not be enough.



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