Pulmonology Coding Alert

Question: An established Medicare patient who has a plan of care in place for her extrinsic asthma reports to the pulmonologist's office to get a Xolair injection. The nurse practitioner (NP) injects the patient with 300 mg of Xolair, then sends the patient home. During the encounter, the supervising physician is reviewing patient charts in the office suite. Can I code this service incident-to the physician?

Missouri Subscriber

Answer: Since there was a supervising physician present, and the NP was following an established plan of care in the office suite, you can report the service incident-to the physician. File the claim under the supervising physician's national provider identifier (NPI) number rather than the NP's. (This action will net the practice 100 percent reimbursement for the codes; billing under the NP's NPI will result in a 15 percent pay reduction.)

On the claim, report the following:

• 90772 (Therapeutic, prophylactic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) for the Xolair injection. (Some payers will accept a chemotherapy administration code for Xolair injections. If the payer considers Xolair chemotherapy, report 96401 [Chemotherapy administration, subcutaneous or intramuscular; non-hormonal anti-neoplastic] instead.)

• 493.00 (Extrinsic asthma; unspecified) linked to 90772 to indicate the medical necessity for the Xolair injection.

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