Otolaryngology Coding Alert

Question: Should I report 95165 to Medicare when the nurse gives each injection or when she administers the first injection from a new vial?

New Jersey Subscriber

Answer: You should report antigen preparation (95165, Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single or multiple antigens [specify number of doses]) when your staff administers the first injection from a new multidose vial. Code for the entire serum at the initial injection encounter, not for the individual portions at each subsequent administration.
 
Suppose an otolaryngologist supervises a nurse who prepares a 10-dose vial containing 5 ccs for a Medicare patient. When the patient presents for his first shot (such as 95115, Professional services for allergen immunotherapy not including provision of allergenic extracts; single injection) from the new vial, you should report 95165 x 5 incident-to the on-duty otolaryngologist. Remember: Medicare defines a billable dose as 1 cc. Don't bill 95165 again until the staff make up another vial.