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EM Coding Alert

You Be the Coder:

Pair Up Immunotherapy with E/M Service

Published on Wed Oct 08, 2014

Question: My pulmonologist assessed a patient suffering from severe pain and fever due to a peritonsillar abscess and the patient received her scheduled bimonthly series of allergy immunotherapy for allergic rhinitis due to dander. What would I report?

Tennessee Subscriber 

Answer: You can report 95115 (Professional services for allergen immunotherapy not including provision of allergenic extracts; single injection) and an E/M service from the 99211-99215 (Office or other outpatient visit for the evaluation and management of an established patient...) range. You should attach 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 to indicate that the E/M service was separately identifiable from the injection. 
Since your pulmonologist evaluated the patient for a problem that was not in any way related to the allergy immunotherapy, you are justified in using a modifier to unbundle the codes and claim compensation for both the codes.
 
Diagnosis help: For the abscess, you would report 475 (Peritonsillar abscess) and for the allergy immunotherapy report 477.2 (Allergic rhinitis, due to animal [cat] [dog] hair and dander) in ICD-9. For the abscess, report J36 (Peritonsillar abscess) and for the allergy immunotherapy report J30.81 (Allergic rhinitis, due to animal [cat] [dog] hair and dander) in ICD-10. 

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