You code it: Asthma patient receives Xolair injection Don't forget documentation: You must back your Xolair injection claims with strong documentation, or you will likely receive rejections.
A completed CMS-1500 form for administration of omalizumab (Xolair) requires four pieces. See if you can identify all four when coding this sample scenario.
Scenario: An established patient who has extrinsic asthma due to house-dust sensitivity comes to the office for administration of Xolair, a monoclonal antibody. A nurse administers 150 mg of Xolair by injection into the patient under direct physician supervision and sends him home. You should report:
- 493.00 (Extrinsic asthma; unspecified) to indicate the medical necessity for the Xolair injection
- 90772 (Therapeutic, prophylactic or diagnostic injection; subcutaneous or intramuscular) in complying with the recommendations of the ATS and ACCP for the Xolair injection; or when permitted by payer, use 96401 (Chemotherapy administration, subcutaneous or intramuscular; non-hormonal anti-neoplastic)
- J2357 (Injection, omalizumab, 5 mg) x 30 for the supply of Xolair.
Check out these documentation requirements for Xolair injections, from Cigna's North Carolina local coverage determination (LCD):
- -Office records must clearly document the reason and frequency for the drug (Xolair) use.-
- -The documentation must reflect the dose administered, the current weight of the beneficiary, and the initial IgE level.-
- -Office records must also support the continued use of the drug.-
- -This information and an appropriate history and physical examination must be available if requested by the carrier to determine coverage.-