Pulmonology Coding Alert

And don't forget to code for the supply, or you'll lose $$When the pulmonologist (or a staff member) injects a patient with omalizumab (Xolair), you may wonder if you can code the encounter with a chemotherapy administration code. Although there's been no official guidance handed down on the matter, evidence from the coding world strongly suggests Xolair shots are not chemotherapy.Here's why you can quash all thoughts of chemotherapy injection codes for this service, and how to code your Xolair injection encounters correctly every time.Use 96401 for Chemotherapy Drugs OnlyCPT has not yet offered any definite ruling on coding Xolair injections, but it is clear that most pulmonology practices and societies recommend using standard injection codes for Xolair. That's what CPT's Drug Infusion Workgroup recommended during a 2007 meeting, and it's what Cheryl Klarkowski, RHIT, CPC, does on Xolair claims.Administration coding: When you code for the Xolair administration, report 90772 (Therapeutic, prophylactic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular), not 96401 (Chemotherapy administration, subcutaneous or intramuscular; non-hormonal, anti-neoplastic), says Klarkowski, coding specialist at Baycare Health Systems in Green Bay, Wis."It would be incorrect to bill for administration of Xolair with 96401, as Xolair is not an anti-neoplastic, which is required for this code," says Cindy Parman, CPC-H, RCC, co-owner of Coding Strategies Inc. in Powder Springs, Ga., and president of the American Academy of Professional Coders (AAPC) National Advisory Board.Cigna Government Service's August 2006 Part B Medicare update offers this guidance: "Chemotherapy administration codes will apply to parenteral administration of non-radionuclide anti-neoplastic drugs and also anti-neoplastic agents provided for the treatment of non-cancer diagnoses (e.g., cyclophosphamide for autoimmune conditions), or to substances such as monoclonal antibody agents and other biologic response modifiers."If the drug you are administering does not fit Cigna's description, you cannot use a chemotherapy injection code. Xolair does not appear to meet this description.Note: Despite evidence strongly suggesting Xolair is not a chemotherapy drug, a few payers might still want you to use 96401 for Xolair injections. So be sure of the payer's preference before coding Xolair injections.Prove Patient's Asthma on Xolair ClaimsYour pulmonologist's staff will administer Xolair for patients with asthma, though the specific type of asthma may vary, Klarkowski says.According to Empire Medicare article number A46088, "Omalizumab (e.g., Xolair) -- Related to LCD L25820," the only diagnosis codes that prove medical necessity for Xolair are:• 493.00 -- Extrinsic asthma; unspecified• 493.10 -- Intrinsic asthma; unspecified• 493.20 -- Chronic obstructive asthma; unspecified• 493.90 -- Asthma, unspecified.You'll also have to be sure the patient meets other medical-necessity requirements for Xolair therapy. According to BlueCross BlueShield of Tennessee's Medical Policy Manual, Xolair is considered medically appropriate for individuals who:• are 12 years of age or [...]