Pulmonology Coding Alert

Question: Often, asthma patients must receive multiple administrations of Xolair and I am not sure how many times I can report CPT 96372 for one encounter. Could you provide an example?

Wyoming Subscriber

Answer: To help guide you through your next encounter with Xolair, consider this case scenario: An established patient with atopic asthma reports to the pulmonologist for a scheduled Xolair injection session.

Under direct physician supervision, the nurse practitioner gives the patient three separate injections of Xolair (each shot is 50 mg).

On the claim, you would report the following:

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

• 96372 appended with modifier 76 (Repeat procedure or service by same physician) for the second injection

• 96372-76 for the third injection

• 493.00 (Extrinsic asthma; unspecified) linked to all the injection codes for the patient's condition

• J2357 (Injection, omalizumab, 5 mg) x 30 for the supply of Xolair.