Otolaryngology Coding Alert

Question: When administering allergy shots to a patient whose otolaryngologist is off-duty that day, should I bill the service under that doctor or the physician who is in the office? Does the patient have to come in on the day his doctor is in?

Tennessee Subscriber

Answer: You should bill the injection code, such as 95120 (Professional services for allergen immunotherapy in prescribing physician's office or institution, including provision of allergenic extract; single injection), under the name of the physician who is present in the office that day. Because a nonphysician practitioner usually provides this service, you will probably bill the shot "incident-to" the on-duty doctor, using his or her provider identification number.

Although the patient does not have to come in on the day his otolaryngologist is in, Medicare requires direct personal supervision for shot administration. This level of supervision requires a physician to be present in the office suite during injection administration. The doctor does not have to be in the same room as the patients, but he must be immediately accessible in case a patient has anaphylaxis. This doctor is directly responsible and liable for the patient's safety, which is why you should bill the service to him and not the out-of-office physician. In addition, billing the injection to the off-duty doctor would violate Medicare's direct-supervision rules.

Depending on the services your office provides, you should report the immunotherapy and provisioning codes (95120-95133) or the immunotherapy-only codes (95115-95117). Note that 95120-95133 include administration in the prescribing physician's office. Thus, assuming the otolaryngologist orders immunotherapy and provides the extracts, you should use these codes based on the number and type of injections. The codes do not stipulate that the prescribing physician administer the injections. They instead specify that the administration must occur in his office. If your office does not supply the extracts, you should report 95115 (Professional services for allergen immunotherapy not including provision of allergenic extracts; single injection) or 95117 ( two or more injections). The billing method incident-to the supervising physician remains the same.

Answers to You Be the Coder and Reader Questions answered by Barbara Cobuzzi, MBA, CPC, CPC-H, an otolaryngology coding and reimbursement specialist and president of Cash Flow Solutions, a medical billing firm in Lakewood, N.J.; Darlene Reed, CPC, certified coder for Northland Ear, Nose and Throat in Liberty, Mo.; and Julie Robertson, CPC, an otolaryngology coding and reimbursement specialist for University ENTSpecialists in Cincinnati.