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Xolair Omalizumab Injection

Lina Posted Thu 13th of November, 2014 13:38:51 PM

Hi,
Need your help to code Xolair injection
The patient purchased the medicine himself and the doctor injected it like chemotherapy , in both hands total 375 mg
so I'm thinking 96401 (with J2357x30 units in box 19)
96401 59 (with J2357x30units in box 19)
Does this look right?

SuperCoder Answered Thu 13th of November, 2014 14:02:26 PM

Thanks for your question. Since your office did not incur the cost of the drug being that the patient brought in their own drug, you would only bill the administration. The administration of the drug does represent an expense to the physician (for the office, staff and equipment), and therefore, you can report it. There has been much controversy over the correct code to select for Xolair administration. Although categorized as a monoclonal antibody which would make you lean towards reporting 96401 (Chemotherapy administration, subcutaneous or intramuscular; non-hormonal anti-neoplastic), most payers require you to report 96372 (Therapeutic, prophylactic, or diagnostic injection [specify the substance or drug]; subcutaneous or intra muscular) due to the fact that the use of Xolair is not anti-neoplastic in nature.

If you see the notes for 96401, it includes the instructions to use 96372 for non-antineoplastic hormonal therapy injections. Without specific instruction allowing the physician to bill 96401 for Xolair administration, the more appropriate code to report is 96732. Most payers who once allowed reporting of 96401 for Xolair administration have revised their guidelines to only allow 96372. Please check with your payers for definitive guidance.

https://www.supercoder.com/coding-newsletters/my-pulmonology-coding-alert/you-be-the-coder-avoid-confusion-over-reporting-xolair-administration-138430-article

https://www.supercoder.com/coding-newsletters/my-pulmonology-coding-alert/you-be-the-coder-dont-confuse-96401-with-96372-for-xolair-administration-article

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