Otolaryngology Coding Alert

Question: We are using codes 99211, 95125 and 95165. We use 95165 only when vials are made up. I am now told that 95165 is an unbundled service. What code should I use?

Sharon Nulk
Wakefield, R.I.

Answer: Code 95165 (professional services for supervision and provision of antigens for allergen immunotherapy; single or multiple antigens [specify number of doses]) is never billed with 95125 (professional services for allergen immunotherapy in prescribing physicians office or institution, including provision of allergenic extract; two or more injections) because 95125 includes the provision of the allergenic extract, says Barbara Cobuzzi, MBA, CPC, CPC-H, an independent coding and reimbursement specialist in Lakewood, N.J. To bill 95165 for the making of the vial, the shot would have to be billed either as 95115 (professional services for allergen immunotherapy not including provision of allergenic extracts; single injection) or 95117 (two or more injections). In other words, you either bill 95125, which includes the extract and the shot, or you bill 95165 along with 95115 or 95117.

Code 99211 (established patient visit, level one) should not be billed unless the patient also has another separately reportable problem, adds Susan Callaway-Stradley, CPC, CCS-P, an independent coding and reimbursement specialist in North Augusta, S.C. This code is billed appropriately if, for example, a nurse questioned a patient who has been having asthmatic reactions to the allergy shots about those reactions and any other problems since the last injection. It should not be billed for basic questions, such as, Did you have any problems with the last injection? because it is expected that this question will be asked to every patient who receives an allergy injection.