Loni Posted Wed 27th of March, 2019 11:32:14 AM
How do you know when to use 96401 or 96372 for administration for a monoclonal antibody if the carrier either doesn't specify (new drug with no J code) or the language says to use "96401 OR 96372"? This question is specific to the monoclonal anitibody Dupixent, used for both dermatitis and asthma. There is no clear language for this. Please help!
SuperCoder Answered Thu 28th of March, 2019 05:32:35 AM
In CPT 96401 (Chemotherapy administration, subcutaneous or intramuscular; non-hormonal anti-neoplastic), the provider administers nonhormonal, antineoplastic chemotherapy drugs subcutaneously or intramuscularly to the patient. However, DUPIXENT is indicated for the treatment of patients with moderate-to-severe atopic dermatitis whose disease is not adequately controlled with topical prescription therapies or when those therapies are not advisable. DUPIXENT can be used with or without topical corticosteroids and it is also indicated as an add-on maintenance treatment in patients with moderate-to-severe asthma with an eosinophilic phenotype or with oral corticosteroid dependent asthma. Which is not the non-hormonal and/or anti-neoplastic chemotherapy. So, in this case it is clear to use the CPT 96372 (Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular). In the CPT code 96372, a therapeutic (like DUPIXENT), prophylactic, or diagnostic substance (a fluid, a drug, etc.) is injected via intramuscular or subcutaneous route into the patient's body. The procedure is performed by the physician himself or by his assistant or nurse under direct supervision of the physician. Whereas, injection of a vaccine or toxoid is not included in this code.
Hope this helps!