Otolaryngology Coding Alert

Question: The June 2003 Otolaryngology Coding Alert reader question "Follow Daily Shot Protocol" stated that "Depending on the services your office provides, you should report the immunotherapy and provisioning codes (95120-95133) or the immunotherapy-only codes (95115-95117)." Does this apply to Medicare or private payers?

New Jersey Subscriber

Answer: The initial coding recommendation applied only to third-party payers. Later, it indicated that Medicare does not allow billing the complete-service codes (95120-95134). You should check with private payers for their rules because some apply Medicare's rule and require the unbundled codes.

When reporting allergy immunotherapy services to Medicare, you should always use the component codes (95115, 95117, 95144-95170). For the injection administration, assign the injection-only codes (95115, Professional services for allergen immunotherapy not including provision of allergenic extracts; single injection; or 95117, two or more injections). If your otolaryngologist prepares the antigens, you should also report antigen preparation (95144-95170).

Many private payers, however, follow Medicare's incident-to requirements, which require the physician to provide direct personal supervision to bill services incident-to a physician. For instance, a nurse performs 95115 and she bills it under a doctor's personal identification number. She should use the on-duty physician's number because he supervises that service on the given date.