Otolaryngology Coding Alert

The key to reimbursement is knowing how to report all the services If your allergist treats patients for serious allergic reactions, you'll need to report injection, nebulizer, E/M and critical-care codes for the anaphylactic-shock treatment. Here's how.

Take a look at the following complex scenario, and then write down your coding choices before referring to the correct solution below. The Scenario: Patient Has Severe Reactions A 25-year-old female patient comes in after a yellow-jacket sting. The sting site shows signs of swelling and redness.

During the examination, the patient begins to wheeze. Her blood pressure drops, and she shows signs of abdominal cramping and altered consciousness. The physician intramuscularly administers 1 mg of dexamethasone acetate and 0.18 ml of epinephrine.

After about five minutes, the patient's signs begin to subside, and the physician gives a 25-mg shot of diphenhydramine hydrochloride and administers a nebulized albuterol treatment.

The patient's condition is stable within 15 minutes. The physician and a nurse monitor the patient off and on during the next three hours. The Solution: Watch Drug Administration, E/M Services In the above instance, you should report three units of G0351 (Therapeutic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) for the intramuscular dexamethasone acetate injection, the epinephrine injection and the diphenhydramine hydrochloride injection.

In addition to G0351, you should also report J1094 (Injection, dexamethasone acetate, 1 mg) for the 1 mg of dexamethasone acetate that the physician injected and J0170 (Injection, adrenaline, epinephrine, up to 1-ml ampule) for the epinephrine he administered, says Alan L. Plummer, MD, professor of medicine, Division of Pulmonary, Allergy and Critical Care at Emory University School of Medicine in Atlanta.

Next: Report J1200 (Injection, diphenhydramine HCl, up to 50 mg) for the 25 mg of diphenhydramine hydrochloride and 94640 (Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes [e.g., with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device]) for the nebulized albuterol treatment, Plummer says. Time Will Tell When Reporting 99214 or 99291 Although the patient's symptoms were initially life-threatening, she shows signs of organ stability prior to reaching the 30 minutes of instability necessary to bill critical care services.

In this instance, you can choose to report a high-level E/M code, such as 99214 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: a detailed history; a detailed examination; medical decision-making of moderate complexity ...) or 99215 (... a comprehensive history; a comprehensive examination; medical decision-making of high complexity ...), in addition to the other procedure and drug codes, Plummer says.

Alternative: You can also take your pick [...]