Primary Care Coding Alert

Question: An established 19-year-old patient with allergic asthma reports to the FP for a scheduled Xolair injection. A qualified nonphysician practitioner (NPP) injects the patient twice with 50 mg of Xolair. Can I report an injection code for this, or is it considered an E/M service since an NPP performed the injection?

Georgia Subscriber

Answer: Your code choice will depend on what role, if any, the FP had in the encounter.

Option 1: If the FP provides direct supervision during the encounter, then you should report the following:

" 96372 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) for the first Xolair injection

" 96372 for the second injection

" Modifier 76 (Repeat procedure by same physician) appended to the second 96372

" 493.90 (Asthma; unspecified) linked to all the injection codes to represent the patients condition

" J2357 (Injection, omalizumab, 5 mg) x 20 for the Xolair supply.

Option 2: If the FP did not provide direct supervision or perform the injections, then you must choose 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician. Usually, the presenting problems are minimal ...) for the NPPs services, with 493.90 appended. You can still report J2357 x 20 for supply of Xolair, but not 96372.