Advanced Search

Pulmonology Coding Alert

Reader Questions:

Established Plan Of Care Ensures Incident-To Physician Claim

Published on Mon Apr 18, 2011

Question:

The nurse administered a 300 mg Xolair injection to an established patient in a private office setting who has a plan of care for her extrinsic asthma. After overseeing the injection, the nurse sent the patient home. The pulmonologist supervised the encounter the whole time, even reviewed the patient charts in his office. I think this warrants an incident-to the physician billing. Any thoughts?

New Mexico Subscriber

Answer:

You are correct. Since a supervising physician was present, and the NP was following an established plan of care in the office suite, you can report the service as incident-to the physician. File the claim under the supervising physician's national provider identifier (NPI) number rather than the NP's. (You should expect a 100 percent reimbursement for the codes when you report incident-to the physician; billing under the NP's NPI will result in a 15 percent pay reduction.)

On the claim, report the following:

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

493.00 (Extrinsic asthma; unspecified) linked to 96372 to indicate the medical necessity for the Xolair injection.

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

Other Articles in this issue of

Pulmonology Coding Alert

View All