EM Coding Alert

Question: Can I bill for an E/M visit for an allergy evaluation and an allergy injection on the same day?

New York Subscriber

Answer: Typically, the physician and allergist do not perform these services on the same day. More often than not, the patient will see the physician for an E/M visit, get referred to the allergist for testing, and then will present at a later date for an allergy injection once the allergist has the patient tested and develops the serum.

In some instances, the patient may be receiving allergy injections, and additional evaluation is needed by the physician to determine efficacy of treatment or to reevaluate the frequency of injections (i.e. weekly versus biweekly).

In these cases, you may separately bill for the E/M encounter in addition to the allergy injection. You will append modifier 25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service) to the E/M code.

Coder’s note: It would be incorrect to bill for the E/M visit without modifier 25 under the reasoning that the two separate clinicians perform the respective services. As modifier 25 states in the code description, it’s a significant, separately identifiable E/M service by the same or other qualified healthcare professional. In this case, the allergist or nurse practitioner (NP) performs the injection, and the otolaryngologist performs the E/M visit.