Code Separately Identifiable Services When Treating Anaphylaxis

Although anaphylactic reactions (also known as anaphylactic shock or anaphylaxis) are rare, they can be extremely serious. The patient may stop breathing, and the physician must suddenly provide other E/M services and medications - which are usually separately payable.

Anaphylaxis is an acute systemic allergic reaction that occurs when the immune system recognizes a substance as a threat. On subsequent exposure to the same substance, a sudden response involving the entire body occurs. Such reactions range from mild to severe, and may take place in response to any allergen.

The condition should be treated immediately with epinephrine. If no improvement is noted within five minutes, a second injection is performed. Antihistamines, such as Benadryl and cortisone injections, could also be given. Nebulizer treatment and the accompanying pulmonary function tests - before and after the treatment - may be performed to improve airway access, says Lori Wyville, office manager of a general allergy practice in Houston.

Bill Separately for Services Provided

Treatment of anaphylactic shock should be coded either 99291 (critical care services) or 9921x ( established patient visit), says Susan Callaway, CPC, CCS-P, an independent coding and reimbursement specialist and educator in North Augusta, S.C.

If the patient cannot breathe or is unconscious and requires CPR (i.e., if the service is not performed, the patient will die), and if the physician spends at least 30 minutes with the patient, critical care services may be billed. Time spent performing separately billable services (such as CPR, intubation or providing an emergency tracheostomy) cannot be included in the critical care time, which must be well documented.

"The issue is, did the physician spend 30 minutes providing critical care to the patient? In most cases, epinephrine will resolve the condition before that," Callaway says. She notes that when critical care services do not total 30 minutes, CPT instructs physicians to use the appropriate-level E/M code - in this case an established patient office visit (99212-99215).

According to CPT, critical care ends when the patient becomes stable. "If it took five minutes for the epinephrine to take effect and the rest of the visit is spent ensuring the patient is well enough to go home, critical care is not an option. A high-level established patient visit should be billed," Callaway advises.

Prolonged Services May Be Appropriate

Callaway adds that prolonged services (99354) may also be appropriate if the visit extends beyond the base time defined by CPT for a given E/M level (for example, 99214's base time is 25 minutes).

An established patient code (with prolonged services, if appropriate) should also be billed if the patient's reaction is not immediately life-threatening. In such cases, the physician administers epinephrine or a similar medication. If the patient responds, additional medications, such as antihistamines and steroids, [...]

- Published on 2001-06-01