Coding

This guide includes general descriptions of coding, billing, coverage, and reimbursement matters related to the use of Activase (t-PA) and is provided for informational purposes only. Please consult Centers for Medicare & Medicaid Services or other payers to verify appropriate codes and learn about payer coverage policies, reimbursement rates, or billing requirements.

The submission and completion of reimbursement- or coverage-related documentation are the responsibility of the patient and healthcare provider. Genentech, Inc. and its subsidiaries make no representation or guarantees concerning reimbursement or coverage for any service or item.

Hospital inpatient coding overview

Hospitals use International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes to identify the diagnoses and procedures associated with inpatient stays.

ICD-9-CM diagnosis codes are used to identify diseases and conditions, and provide documentation for any procedures performed on a patient. All appropriate ICD-9-CM diagnosis codes should be reported on the claim form. ICD-9-CM procedure codes are used to identify services or treatment provided to patients in the hospital inpatient setting. ICD-9-CM diagnosis and procedure codes should be reported to the highest level of specificity. Some payers may require additional coding and patient-specific clinical information to determine coverage and payment for the inpatient stay.

Hospitals should code all diagnoses and procedures appropriately. Please consult payers to verify appropriate codes and learn about payer coverage policies, reimbursement rates, or billing requirements.

The coding reference provided below outlines the basic codes that may be applicable to a hospital inpatient acute ischemic stroke case involving Activase (t-PA). The following codes are not inclusive of all applicable codes that may be included on the claim for an individual patient. Hospitals should document and bill all appropriate ICD-9-CM diagnosis and procedure codes:

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ICD-9-CM diagnosis codes	ICD-9-CM procedure codes
Stroke 433.x1 Occlusion and stenosis of precerebral arteries 434.x1 Occlusion of cerebral arteries Pulmonary embolism 415.11 Iatrogenic pulmonary embolism and infarction 415.19 Pulmonary embolism and infarction, other	Stroke and pulmonary embolism 99.10Injection or infusion of thrombolytic agent

Hospital outpatient coding overview

On claim forms, hospitals use International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes to report patient diagnoses and Healthcare Common Procedural Coding System (HCPCS) Level II codes and American Medical Association (AMA) Current Procedural Terminology (CPT®*) to report items and procedures provided during outpatient encounters. ICD-9-CM diagnosis codes are used to identify diseases and conditions, and provide justification for any procedures performed on the patient. All appropriate ICD-9-CM diagnosis codes should be reported on the claim form. ICD-9-CM diagnosis codes should be reported to the highest level of specificity. Medicare may require additional coding and patient-specific clinical information to determine coverage and payment for the outpatient visit. CPT codes are 5-digit number codes created by the AMA to designate specific procedures performed. HCPCS Level II codes are used to identify items like drugs and supplies, as well as services not described by CPT codes. The HCPCS codes used to identify drugs are often referred to as J codes.

Physician services coding

A CMS-1500 claim form that reflects the administration of Activase (t-PA) when used in acute ischemic stroke by a physician may include the following codes. Please note that because the hospital provides the Activase (t-PA), the hospital would bill the payer for Activase (t-PA). The physician would only bill for services provided, such as the administration of Activase (t-PA). The coding reference provided below outlines the basic codes that may be applicable to physician billing for treatment of an acute ischemic stroke case involving Activase (t-PA). The following codes are not inclusive of all applicable codes that may be included on the claim for an individual patient. Physicians should document and bill all appropriate ICD-9-CM diagnosis and procedure codes:

ICD-9-CM diagnosis codes	CPT† codes
Stroke 433.x1 Occlusion and stenosis of precerebral arteries 434.x1 Occlusion of cerebral arteries Pulmonary embolism 415.11 Iatrogenic pulmonary embolism and infarction 415.19 Pulmonary embolism and infarction, other	Stroke CPT 37195Thrombolysis, cerebral, by intravenous infusion Pulmonary embolism CPT 37201Transcatheter therapy, infusion for thrombolysis other than coronary

Stroke conditions and critical care services coding

Patient diagnoses and services furnished by the attending physician(s) must be documented appropriately at all times. It is the responsibility of the neurologist to report the ICD-9-CM diagnosis codes and CPT^®* codes that most accurately identify the patient's stroke condition and all services provided to them respectively.

To assist neurologists in coding appropriately, the American Academy of Neurology has provided the following resources as guides to understanding coding for cerebrovascular diseases and critical care services provided to stroke patients.

A Neurologist's Guide to Using ICD-9-CM Codes for Cerebrovascular Diseases

Stroke Coding Guide for Critical Care Coding

Please note that in this case, critical care services refer specifically to the evaluation and management of a critically ill patient. The neurologist may also bill for the administration of Activase (t-PA) if used in stroke treatment. The appropriate billing code may vary based on indication. Neurologists should thus confirm the appropriate codes with each payer (eg, Medicare or private/commercial payer).

Telestroke coding

The National Center for Health Statistics (NCHS) has issued a new ICD-9-CM diagnosis V-code, effective October 1, 2008, to identify acute ischemic stroke patients who had been treated with t-PA at a different facility within 24 hours of admission to the current facility. Generally, ICD-9-CM "V-codes" identify factors, other than a disease or injury, which may be relevant to the patient's treatment. This new code may be relevant to healthcare providers using Activase (t-PA) for stroke treatment due to the growing occurrence of "drip and ship" scenarios in stroke management. The full descriptor for the code is provided below:

ICD-9-CM codes	CPT† codes
V45.88 Status postadministration of t-PA (rt-PA) in a different facility within the last 24 hours prior to admission to current facility	0188TRemote, real-time interactive videoconferenced critical care, evaluation, and management of the critically ill or critically injured patient; first 30-74 minutes 0189TEach additional 30 minutes (list separately in addition to code for primary service)

For more information on the new V-code, visit the American Academy of Neurology Web site at http://www.aan.com/news/?event=read&article_id=5264

*
CPT is a registered trademark of the American Medical Association. Current Procedural Terminology (CPT) is copyright 2009 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.

^†
All Current Procedural Terminology (CPT) five-digit numeric codes, descriptions, numeric modifiers, instructions, guidelines, and other material are Copyright 2009 American Medical Association. All rights reserved.

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