Allergy Coding Alert
Reader Question: Self-Administered Shots
Question: How should I bill for patients who administer their shots at home? We transfer the antigens from a multiple-dose (10 doses) to a single-dose vial and usually give patients a six-week single-dose supply (six vials).
New Hampshire Subscriber
Answer: The correct code is 95144 (professional services for the supervision and provision of antigens for allergen immunotherapy, single or multiple antigens, single dose vials [specify number of vials]). This code applies whenever the shots are not administered by the same physician who prepared the allergen, including self-administration by the patient.
The number of vials prepared for the patient should be entered in the units box on the claim form. In this case, six single-dose vials are prepared, so 6 should be entered in the units box. The preparation of the multi-dose (10-dose) vial should not be reported as well, even though four additional doses were prepared and remain in the multi-dose vial. The remaining four doses may be billed when additional single-dose vials are provided.
Single-dose vials are more expensive than multiple-dose vials, which are reported with 95165 (professional services for the supervision and provision of antigens for allergen immunotherapy; single or multiple antigens [specify number of doses]). As a result, Medicare carriers will pay for single-dose vials only when the allergy shots are administered by a different physician or an individual who can ensure the correct dosage. If the same physician who prepared the antigen delivers the shots, 95144 should not be coded even if single-dose vials were used. Instead, 95165 should be billed, with the appropriate number of doses in the units box of the claim form.
Note: Some physicians do not allow their patients to self-administer. And some carriers may not permit self-administration of allergy shots in their allergy coverage policies.
New Hampshire Subscriber
Answer: The correct code is 95144 (professional services for the supervision and provision of antigens for allergen immunotherapy, single or multiple antigens, single dose vials [specify number of vials]). This code applies whenever the shots are not administered by the same physician who prepared the allergen, including self-administration by the patient.
The number of vials prepared for the patient should be entered in the units box on the claim form. In this case, six single-dose vials are prepared, so 6 should be entered in the units box. The preparation of the multi-dose (10-dose) vial should not be reported as well, even though four additional doses were prepared and remain in the multi-dose vial. The remaining four doses may be billed when additional single-dose vials are provided.
Single-dose vials are more expensive than multiple-dose vials, which are reported with 95165 (professional services for the supervision and provision of antigens for allergen immunotherapy; single or multiple antigens [specify number of doses]). As a result, Medicare carriers will pay for single-dose vials only when the allergy shots are administered by a different physician or an individual who can ensure the correct dosage. If the same physician who prepared the antigen delivers the shots, 95144 should not be coded even if single-dose vials were used. Instead, 95165 should be billed, with the appropriate number of doses in the units box of the claim form.
Note: Some physicians do not allow their patients to self-administer. And some carriers may not permit self-administration of allergy shots in their allergy coverage policies.
- Published on 2001-09-01
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