Otolaryngology Coding Alert

Answer: The CPT clearly states that 95117 is for two or more shots, so no units apply. Most carriers follow this guideline, although it is possible that some third-party payers choose to reimburse allergy shots differently.

Kathy Zmuda, CPC, lead inpatient coder for Cigna Healthcare in Scottsdale, Ariz., notes that if antigens are being mixed there are separate codes that also should be billed. Unlike the allergy injection code, these codes may be billed according to the number of units, resulting in substantial reimbursement.

If all the physician is doing is billing two or more injec-tions, they should code 95117. But if they also are mixing the allergens, they can bill that in one of two waysin one lump sum or with each injection. Billing the allergens out in a lump sum (CPT codes 95145-95170) reimburses better, she adds.

For example, an otolaryngologist may need to mix multiple doses of antigens specifically for a patient who is allergic to grass and certain foods. This procedure (95165, professional services for the supervision and provision of antigens for allergen immunotherapy; single or multiple antigens [specify number of doses]) is billed out according to the number of doses mixed, not the number of antigens in the doses. If the vial contains 20 antigens and eight doses, the physician bills for eight doses. The number of doses goes in the units column when filing the claim.

These codes, along with 95144 (professional services for the supervision and provision of antigens for allergen immunotherapy, single or multiple antigens, single dose vials [specify number of vials]), should be used in conjunction with 95115 and 95117. Code 95144 is for single dose vials, where the physician empties a vial, pokes it into an arm, and disposes of the bottle. At the subsequent visit, the physician uses the next bottle marked in the sequence. In most parts of the country, this is not a common way to provide antigens.

Another series of codes, 95120-95134, is used when the physician actually draws up each individual shot separately. The physician has a board with as many as 300 different vials of antigens (for roaches, dustmites, etc.). Each patient has an injection schedule in their chart, and each individual antigen is mixed when the patient arrives so that the physician has more control over the doses the patient receives by titrating dosages (i.e., modifying doses in tiny increments).

Any claim using codes 95120-95134 cannot contain codes 95115 or 95117 because the injection is already included.

Note: Always check with your carrier first. Many have specific guidelines for billing allergy injections that dont follow CPT rules