t-PA administration-Neurology Question

I'm new to the site and perhaps this has been answered previously, but I keep getting denied on t-PA administration even though it significantly improves the patient's quality of life and results in usually less medical expense. The physician always administers t-PA within the 3 hour window and it is always in the emergency room. Does anyone have experience with this, in particular, getting paid? Thank you.

What kind of doc?

What code are you billing for the t-PA admin? Don't think there is a code for it since it happens in the ED but that is a critical care situation and should be billed for the consultation and the critical care code if the doc was in the ED the whole time.

tPA

In the Emergency room, the staff and drugs are billed by the facility. The medical decision Making for an E/M would be mod/high complexity for the physician. The physician may also bill critical care instead of E/M if condition warrants. What are you billing that is being denied?

t-PA administration

Where is the patient? If the patient is in the ED, perhaps the payers are assuming that the administration is a facility charge/expense, and not a physician charge/expense.

Sorry, just figured out how to find my question

I am billing a 99215 along with a 37195. I did get paid ONE time by an insurance carrier but never again by anybody. I know the hospital charges for the medication itself; however, a neurologist who has had extra training actually is the the one who does the infusion. For some reason, our neurologist is the one they call all the time even though there are several others on staff (at least it seems that way). He is called even when he isn't on call. Thanks for answering my questions.

P.S. For some reason I was looking for an email that said my question had been answered. Again, I apologize for the delay in writing back.

Here is an article for you

http://archneur.ama-assn.org/cgi/content/full/63/5/661

It looks like the insurers just don't pay the code.
Why would you bill a 99215? That is an office code!
I would bill critical care and/or prolonged services codes since the doc stands there and watches to see if they get better or bleed.

Sorry, I put the wrong code on there

It should have been 99291 instead of 99215 - sorry, you're right - it's an office visit. Don't know what my fingers were thinking.

Thank you

Thanks for the article to look up.