Pulmonology Coding Alert

Question: How do you know whether to use CPT^® code 96401 or 96372 for administration of a monoclonal antibody if the carrier either doesn’t specify which code to use? This question is specific to the monoclonal antibody Dupixent® (dupilumab), used for both dermatitis and asthma. There is no clear guidance for this. Please help.

Codify Subscriber

Answer: Without guidance, it’s certainly difficult to know what to choose. The key is in understanding that Dupixent® is not a non-hormonal and/or anti-neoplastic chemotherapy. It’s used to treat patients with moderate-to-severe atopic dermatitis whose disease is not adequately controlled with topical prescription therapies or when those therapies are not advisable. It’s also an add-on maintenance treatment in asthma patients with an eosinophilic phenotype or with oral corticosteroid dependent asthma.

In this case, you would report code 96372 (Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular) for the Dupixent^® administration.

Code 96401 (Chemotherapy administration, subcutaneous or intramuscular; non-hormonal anti-neoplastic) would be your choice if the drug being administered is a non-hormonal, antineoplastic chemotherapy drug.

Just to say: Your provider’s injection services are covered in code 96372 and wouldn’t be coded separately. Generally, you can report the appropriate HCPCS code for the injectable product, as long as the physician practice paid for the drug. If the patient picked up the drug at his/her pharmacy and brought it to the physician office for administration, your pulmonologist can only bill for the administration.