Reader Questions: Nix 99211 for Allergy Injection Monitoring

Question: May I bill 99211 in addition to allergy shots (95115-95117) if the nurse monitored the patient for 10 minutes after administering the shot to make sure he didn't have a bad reaction? Should I attach a modifier?

California Subscriber

 Answer: You may bill E/M services in addition to 95115 (Professional services for allergen immunotherapy not including provision of allergenic extracts; single injection) and 95117 ( two or more injections) only when you provide separately identifiable services at the same time. Monitoring the patient after the injection is included in the injection procedure. It is standard care for any patient who receives an allergy injection to keep him for 20 minutes after the shot and then recheck his arms before allowing him to leave.
 
And, according to section 5202 of the Medicare Carriers Manual, if you know that the sole purpose of an office visit was for the patient to receive an injection, payment may be made only for the injection, if it is covered. A separate additional charge for an office visit would not be warranted when the services did not constitute a regular office visit, the manual states.
 
You should also follow the CPT guidelines to report the code that accurately identifies the service performed. In this case, report 95115 and 95117 instead of 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician ...). Do not bill 99211 in addition to the allergy injection code unless the nurse clearly provides a separate service.