Otolaryngology Coding Alert

Question: A patient came into our practice with her own allergy medication and asked our ENT physician to administer the shots. Is there a way to report the shot without the supply code? And can we also submit an E/M service as well?

Texas Subscriber

Answer: When your physician provides only the injections for the allergy immunotherapy, and the allergenic extracts for the injections came from another source, you should code for the injections only, depending on the number of injections provided. If your physician provided only one injection, reach for CPT^® code 95115 (Professional services for allergen immunotherapy not including provision of allergenic extracts; single injection).

If your physician provides 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 immunotherapy services that your physician performed. The code involves the observation service (to check for allergic reactions) that your physician performed after the injection. Keep in mind that these codes only represent the administration of the extract prepared by your physician or someone from your facility.

Reminder: If your physician administered the antigens sublingually (i.e., by placing drops under the patient’s tongue), then you cannot claim reimbursement for the service. Note that antigen(s) administration is covered only if it is injected by your provider.

As for whether you can separately report an E/M service, the answer will depend on the details present in your documentation. The allergy administration codes include a pre-procedure evaluation to ensure that the patient is able to receive the injection and a post-procedure evaluation period to determine if the patient is in jeopardy of an allergic reaction, so you cannot report an E/M code unless a separate identifiable service is performed. Obtaining informed consent is included in the immunotherapy.

Remember that you have to maintain thorough documentation of a separate E/M code (such as 99212-99215, Office or other outpatient visit for the evaluation and management of an established patient...) depending on the level of E/M services provided when a separate service is performed in addition to the allergy immunotherapy. For example, if the patient complains of a sore throat and the physician evaluates the patient for that complaint in addition to the administration of the allergy injection, an E/M service that accounts for the MDM or time associated to working up the patient for their sore throat may be coded in addition to the administration of the allergy immunotherapy. In this situation, add modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to help the payer know that a separate service has been performed in addition to the allergy immunotherapy. Include documentation of the separately identifiable service in the procedure notes so you can back up the separately identifiable nature of the E/M visit if a reviewer ever looks at your notes.