Pulmonology Coding Alert

Question:

New Jersey Subscriber

Answer:

You are right, in the sense that the physician reports the administration only. Since the physician/practice doesn't incur the cost of the drug, the physician/practice should not be reimbursed for this. On the other hand, the administration of the drug does represent an expense to the physician (for the office, staff and equipment), and therefore, you can report it. 

Red flag: There has been much controversy over the correct code to select for Xolair administration.  Although categorized as a monoclonal antibody (which would lend toward reporting 96401, Chemotherapy administration, subcutaneous or intramuscular; non-hormonal anti-neoplastic), most payers require reporting CPT 96372 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug); subcutaneous or intramuscular]) due to the fact that the use of Xolair is not anti-neoplastic in nature.  Without specific instruction allowing physician to bill 96401 for Xolair administration, the more appropriate code to report is 96732.