Oncology & Hematology Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: We have a patient who comes in for follow-up care for breast cancer. In addition, she asks our RN to administer an allergy injection, which she supplies. Should we bill for the E/M visit and drug administration? Or should we only bill the E/M visit?


Idaho Subscriber
      Answer: Allergen immunotherapy services are billed using 95115-95199. The rules for allergy therapy are different from those for injections in hematology/ oncology practices.  
 
The CPT manual states, "Office visit codes may be used in addition to allergen immunotherapy if other identifiable services are provided at that time." For non-Medicare payers, you should ask each payer for its coverage policy and coding requirements.
 
The Medicare Carriers Manual, section 15050 B, addresses allergy immunotherapy. Medicare recognizes  95115 and 95117 when physicians bill for the injection only, and 95144-95170 when billing for an antigen preparation service. If physicians provide both services, both sets of codes are allowed. 
 
Section 15050 C addresses the issue of allergy shots and E/M services on the same day. It states that "Visits should not be billed with allergy injection services 95115 or 95117 unless the visit represents another separately identifiable service." Also, to receive payment for a service provided on the same day that a physician also provides a service in the allergen immunotherapy series (95115-95199), append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the visit code, indicating that the patient's condition required a significant, separately identifiable service above and beyond the allergen immunotherapy service.
 
If you provide this service for your patient, use modifier -25 and provide the payer with documentation.