CPT 2002 Revisions Address Allergen Preparation and Provision

The 2002 CPT manual includes an important change to the wording of eight antigen preparation code descriptors. Adding the word "preparation" to the descriptors should eliminate confusion over how to process claims involving both the preparation and the injection of one or more allergens, says Teresa Thompson, CPC, an allergy coding and reimbursement specialist in Sequim, Wa. CMS now instructs allergists who provide both components to bill for each separately. CPT makes the distinction between injection codes and provision codes clear, explicitly stating that the injection codes do not include "provision" of allergens.
 
The descriptors include:


95144 professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single dose vial(s) (specify number of vials)


95145 professional services for the supervision of preparation and provision of antigens for allergen immunotherapy (specify number of doses); single stinging insect venom


95146 two single stinging insect venoms


95147 three single stinging insect venoms


95148 four single stinging insect venoms


95149 five single stinging insect venoms


95165 professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single or multiple antigens (specify number of doses)


95170 whole body extract of biting insect or other arthropod (specify number of doses).

Many allergists report that some carriers still bundle 95165 with 95115 (professional services for allergen immunotherapy not including provision of allergenic extracts; single injection) or 95117 ( two or more injections) despite CPT's instruction and the fact that these codes were not edited in the Correct Coding Initiative. 
 
Many coding specialists attributed the edits to carrier confusion over what was covered by 95165, in part because the previous descriptor for 95165 listed only the "supervision of provision" and did not explicitly include preparation, which is the main part of the service.
 
Bundling 95165 with 95115 or 95117 is inappropriate under any circumstances and should be appealed, says Barbara Cobuzzi, MBA, CPC, CPC-H, a coding and reimbursement specialist and president of Cash Flow Solutions, a medical billing firm in Lakewood, N.J. "Not only are these two codes not bundled," Cobuzzi points out, "95115 clearly states that it does not include the provision of allergenic extracts, which is reported using 95165."
 
The word "preparation" in the descriptor of the "provision" codes (95144-95170) should clarify the distinction between preparing and injecting allergens.
 
Note: If the carrier still denies payment for 95165, an independent fair hearing appeal should be requested. As long as the services are correctly documented, the denial should be overturned.

How To Select the Correct Allergy Code

Selecting the correct allergy injection code can be difficult, mainly because there are so many codes to choose from and [...]

- Published on 2001-12-01