Otolaryngology Coding Alert

See how to report these different supply scenarios.

Green grass, blossoming trees, and bright sunshine may provide picturesque views, but unfortunately, the pollens in the air during the spring and summer months cause allergies.

When your physician performs allergy testing, you will need to base your code selection on factors such as the type of testing the provider is performing, what they are testing for, and the timing involved for the particular test. If the patient returns for treatment, you need to know how the immunotherapy is supplied, so you know when to turn to an injection-only code.

In Otolaryngology Coding Alert volume 26, number 6 last month, we answered some of the most common allergy testing coding questions. In this issue, we’ll help you clear up any lingering confusion by addressing more FAQs to ensure your allergy testing and immunotherapy reporting is on point.

What’s the Difference Between 95024 and 95027?

“Intracutaneous testing involves injecting the allergen serum just under the skin to see if it elicits a reaction — sequential intracutaneous testing also involves injecting the allergen serum under the skin, but multiple times, in increasing strengths, to see if and when a reaction takes place. The allergy tester starts with a very diluted strength and then injects progressively stronger dilutions, performing three or four tests with the same allergen,” explains Barbara J. Cobuzzi MBA, CPC, COC, CPC-P, CPC-I, CENTC, CPCO, CMCS, of CRN Healthcare Solutions of Tinton Falls, New Jersey. “The otolaryngologist/ allergist often combines scratch testing with intracutaneous (intradermal) testing and sometimes with sequential intracutaneous testing.”

Single intradermal test: Submit 95024 (Intracutaneous (intradermal) tests with allergenic extracts, immediate type reaction, including test interpretation and report by a physician, specify number of tests) when the provider injects small amounts of different allergens into the skin to determine if the patient has an immediate allergic response. You’ll bill the test based on the number of “needle sticks” or allergens tested, as one intradermal injection is administered for each allergen.

Sequential intradermal testing: CPT^® 95027 (Intracutaneous (intradermal) tests, sequential and incremental, with allergenic extracts for airborne allergens, immediate type reaction …) is an example of a sequential intradermal allergy testing code. In sequential testing, the provider tests each allergen multiple times, unlike single intracutaneous testing, which only tests an allergen once. When billing these tests, count the number of sticks (not the number of allergens) to arrive at the number of units, as the provider has to read and measure each test/stick for reaction.

By counting only the intradermal injections, you “will capture exactly the number of dilutions of all of the allergens that were tested and bill the correct number of units for this test,” Cobuzzi notes. “For example, if the provider tests four allergens, and injects the patient with three dilutions of each allergen, the total number of sticks or injections is 4 x 3 or 12. So you would bill 12 units of 95027,” she adds.

How Do I Report Immunotherapy Shots Without Supply?

When patients come in for shots, you’re typically looking for codes to account for the injection as well as preparation of the allergenic extract; however, that won’t be the case if the physician doesn’t supply the therapeutic agent. In cases where the allergenic extract comes from another source, such as a compounding pharmacy or another physician, you’ll turn to injection-only codes that represent only the allergy immunotherapy administration. Which code you use will depend on how many injections the provider performs. If treatment involves one injection, use 95115 (Professional services for allergen immunotherapy not including provision of allergenic extracts; single injection).

However, “some antigens react when they are mixed and cannot be mixed together. In such cases, the provider will use multiple vials to keep the antigens separate, and more than one injection will be needed for the patient to receive correct immunotherapy,” Cobuzzi explains. If the provider administers more than one injection, use 95117 (Professional services for allergen immunotherapy not including provision of allergenic extracts; 2 or more injections) to report the allergy shots.

Note: These immunotherapy codes include the observation service (to check for allergic reactions) that your physician or the clinical staff perform after the injection.

Be sure to submit 95115 and 95117 only for encounters in which the provider injects premixed vials of allergen immunotherapy supplied by another physician or vendor. If the allergy serum is prepared, and a vial is provided to the patient without injection, you’ll report a code from the 95144 (Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy, single dose vial(s) (specify number of vials)) to 95170 (… whole body extract of biting insect or other arthropod (specify number of doses)) group, depending on the type of antigens in the extract.

What Codes Are Used for Allergenic Extract?

Practices may prepare an antigen for allergen immunotherapy and provide the allergenic extract — either in a premixed vial, customized for the patient based on testing, or get it off the board each visit (custom mixing each immunization shot). In such cases, coding is based on the type of preparation, and you’ll report one unit of 95165 (Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single or multiple antigens (specify number of doses)) or 95145 (… single stinging insect venom) to 95149 (… 5 single stinging insect venoms) for each dose of antigen prepared.

Don’t miss: Medicare Part B does not cover dilutions, but if the patient receives an injection of less than 1 cc of allergen extract, “Medicare Part B will only pay for each aliquot, which is 1 cc of undiluted maintenance dose of antigen,” says Cobuzzi. “For non-Medicare Part B payers, the actual doses in the vial may be counted.”

When the patient comes in with their vials prepared somewhere else, only code the injection(s) administered. As always, make sure your documentation fully supports the services provided.

“Third-party payers are auditing the documentation, looking for the mixing documentation — listing what antigens and quantities are included in the vial along with the diluent added and the schedule for usage of each diluted vial,” notes Cobuzzi. “Third-party payers also want to see what antigen the provider has drawn up and injected into what arm on each date with detailed documentation,” she adds.