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Coding Corner: Stop Reporting Xolair Shots With Chemo Codes

CPT is moving to make 90772 the only choice for omalizumab injections

After years of confusion and conflicting information on which code set to choose from, there will finally be some official guidance on reporting encounters in which a facility injects a patient with omalizumab (better known as Xolair).
The verdict: When reporting Xolair shots, use standard injection codes, not chemotherapy administration codes, recommends CPT鈥檚 Drug Infusion Workgroup. The workgroup recently met to discuss the application of the injection codes, but no official word has been handed down yet, says Vicky O鈥橬eil, CPC, CCS-P, president of The Hazlett Group in St. Louis. Still, you should get used to injection codes for Xolair, experts say, because it is difficult to justify the higher-paying chemotherapy code when injecting Xolair.

Best bet: Follow this advice when reporting Xolair injections for your patients -- and wait for official word soon from CPT.
Asthma Patients Get Xolair Most Often
Xolair is a monoclonal antibody the physician injects to treat asthma. When your office staff injects the substance, you should always report 90772 (Therapeutic, prophylactic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) for the service, according to a recent release from Cigna Government Services.

Example: An established patient with atopic asthma comes to the office for an asthma evaluation and for Xolair administration.
 
The physician sees the patient, and then the nurse injects 300 mg of Xolair into the patient and sends him home. On the claim, you should:

鈥� report 90772 for the Xolair injection.

鈥� report J2357 (Injection, omalizumab, 5 mg) x 60 for the supply of Xolair.

鈥� report the appropriate evaluation and management level from the 99211-99215 series for the office visit.

鈥� attach modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code to show that the E/M was separate from the injection.

鈥� link ICD-9 code 493.00 (Extrinsic asthma; unspecified) to 90772 and the E/M code to indicate the medical necessity for the office visit and the injection.
Don鈥檛 forget documentation: You must back your Xolair injection claims with strong documentation, or you鈥檙e likely to receive rejections. Check out these documentation requirements for Xolair injections, from Cigna鈥檚 North Carolina Local Coverage Deter-mination (LCD):
 
鈥� 鈥淥ffice records must clearly document the reason and frequency for the drug (Xolair) use.鈥�

鈥� 鈥淭he documentation must reflect the dose administered, the current weight of the beneficiary, and the initial IgE level.鈥�

鈥� 鈥淥ffice records must also support the continued use of the drug.鈥�

鈥� 鈥淭his information and an appropriate history and physical examination must be available if requested by the carrier to determine coverage.鈥�
Chemo codes a no-no for Cigna: Cigna has not only instructed providers to use 90772 for [...]

- Published on 2006-08-17