Q&A: Avoid coding confusion for TPA

March 4, 2010

Q: Do you code the procedure for tissue plasminogen activator (tPA) administration when it is done in your emergency room for patients being admitted with cerebrovascular accident (CVA)/stroke on inpatient cases?

I believe the procedure code is 99.10 and it makes quite a bit of difference in the DRG. Our coders here tell me they can’t code it when given at our emergency department (ED) but can if has been given at another facility within 24 hours prior to admission at our facility.

A: Yes, you should code 99.10 (tPA administration) when it is administered in your ED prior to admission. There seems to be some confusion between the procedure code and the V-code update in the 2008 ICD-9-CM Coding Manual which states:

“Code V45.88, Status post administration of tPA in a different facility within the last 24 hours prior to admission to current facility.”

The update was created to collect useful information about a patient's recent tPA treatment for a current acute cerebral infarction or myocardial infarction at a different facility.

For example, if a patient had administration of tPA in Facility A and then was transferred to Facility B within 24 hours, facility B should use code V45.88 as a secondary diagnosis code. Facility A would have already coded the procedure code (99.10) for the tPA administration.

Editor’s note: Christina M. Phillips, RHIT, CCS, Coding Manager, at DCH Health System in Tuscaloosa, AL, answered this question.

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