Otolaryngology Coding Alert

Question: When our physician writes a prescription for 10 doses of allergen immunotherapy, should we report 95165 x 10? If not, how should we code for all the vials the physician used, if at all? Should we report 95165 only when the physician actually administers the drugs? We have also heard that the maximum quantity to charge for this code is 20. Is this right?

Alabama Subscriber

Answer: You should report 95165 (Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single or multiple antigens [specify number of doses]) when the physician supervises and prepares the antigen for immunotherapy.  
 
If he prepares 10 doses, you should report 95165 x 10. Medicare requires that you limit reporting 95165 to the number of 1-cc doses per vial.
 
The fee assigned by Medicare is based on 1-cc doses. Even if the amount of the dose the physician prescribes is less than 1 cc (that is, 0.5-cc doses from a 10-cc vial, totaling 20 doses), you are allowed to report the maximum number allowed per 10-cc vial (for billing purposes), which is 10.
 
When a physician administers the immunotherapy, you should bill  the administration code (95115-95117) for each encounter that he administers antigen.

 - Information for Reader Questions and You Be the Coder provided by a number of coding experts, including Carol Pohlig, BSN, RN, CPC, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia; and Alan L. Plummer, MD, professor of medicine, division of pulmonary, allergy and critical care at Emory University School of Medicine in Atlanta.