Pulmonology Coding Alert

Question: Can you clarify which injection code to use with Xolair administration and what the medical necessity requirements are for this drug? New Hampshire Subscriber Answer: When you code for Xolair administration, report 96372 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular). For patients who receive Xolair injections, most payers will want you to have the following documentation available (check your specific policy requirements):an explanation for the reason and frequency for the Xolair use; and a record that includes dose administered, the current weight of the beneficiary, and the patient's initial IgE level. Empire Medicare article number A46088, "Omalizumab (e.g., Xolair) -- Related to LCD L25820" says these diagnosis codes prove medical necessity for Xolair: • 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 [...]