Pulmonology Coding Alert

Don't ignore chemo codes just because your physician doesn't see cancer patients

You won't get paid for Xolair and intravenous immunoglobulin (IVIG) services unless you have a handle on drug-therapy coding. Follow these expert tips to determine the codes to report for omalizumab, Remicade and other drug administrations. 1. Identify the Drug Substance The first question you should ask yourself when choosing an administration codes is what type of drug your pulmonologist administered. The drug type leads you to the category of CPT code you'll select from.

If the agent is an anti-neoplastic drug, a monoclonal antibody, or some other sort of biologic response modifier, you can use the chemotherapy administrations codes (96401-96549). If the drug is not in these categories, use the codes for hydration, therapeutic prophylactic, and diagnostic injections and infusions (90760-90779).

Tip: Remember that you can report the chemotherapy administration codes for any physician who gives these types of medications or substances. An oncologist or radiation oncologist doesn't have to be the one providing the service for you to use these codes, says Vicky O'Neil, CPC, CCS-P, owner of The Hazlett Group, a coding and compliance consulting firm in St. Louis.
 
Pulmonologists commonly care for patients with conditions such as cystic fibrosis, asthma, COPD, and pulmonary hypertension. These conditions can require specialized injection and infusion therapies, such as methotrexate, infliximab, and immune globulin, that are now classified within the chemotherapy section of codes. 2. Determine the Administration Approach Once you've determined the drug substance, the way your pulmonologist administered the drug narrows your code choices even further.
 
When your physician administers a subcutaneous or intramuscular injection, you should use either 96401 (Chemotherapy administration, subcutaneous or intramuscular; non-hormonal anti-neoplastic) or 90772 (Therapeutic, prophylactic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular). If you've identified that your pulmonologist administered a non-hormonal antineoplastic, monoclonal antibody, or biologic response modifier, then you know to choose 96401.

Coding scenario: If your pulmonologist is administering monoclonal antibodies injections for a cancer or non-cancer diagnosis, you should report 96401. For example, your pulmonologist administers omalizumab (Xolair) to a patient with allergic asthma (493.xx). Since Xolair is an IgE blocker or inhibitor that is classified as a monoclonal antibody, 96401 is the appropriate code to report for Xolair injections, O'Neil says.
 
The same concept applies for IV pushes and infusions: If the physician administers a non-hormonal anti-neoplastic, monoclonal antibody, or biologic response modifier, then go to the chemotherapy code section of CPT. Otherwise, use 90765 (Intravenous infusion, for therapy, prophylaxis, or diagnosis [specify substance or drug]; initial, up to 1 hour) and +90766 (... each additional hour, up to 8 hours).

Within the chemotherapy codes, you'll select the right code by determining the administration approach as follows:

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