Part B Insider (Multispecialty) Coding Alert

Question: Our physician recently saw an established allergic asthma patient whose symptoms were not controlled adequately by the previous medications that he was taking. Our physician carefully assessed the patient's previous history, allergy history, medications and symptoms and conducted a thorough evaluation of the patient's asthma, changing the medications.

After the assessment, our physician provided the patient's scheduled allergen immunotherapy. He provided a single injection of the allergen extract and observed the patient for about 30 minutes before releasing the patient and asking him to come back for another injection every week (as scheduled) until specified. How do I report this procedure that our physician performed?

Answer: You will need to report the allergen immunotherapy using the CPT® code 95115 (Professional services for allergen immunotherapy not including provision of allergenic extracts; single injection) as your physician provided only one injection to the patient. If two injections were provided to the patient, then you would have to report the services using the code 95117 (Professional services for allergen immunotherapy not including provision of allergenic extracts; 2 or more injections). The code includes the observation service (to check for allergic reactions) that your physician provided after the injection.

Note that these codes only represent the administration of the prepared extract by your physician or someone from your facility. If the allergen extract is mixed or prepared by someone from another facility, they will report the provision of the allergen extract with 95144 (Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy, single dose vial[s] [specify number of vials]) or 95165 (Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single or multiple antigens [specify number of doses]).

If your physician is directly involved in the preparation of the antigen and also provides the immunotherapy all on the same day, then you should report the services using 95120 (Professional services for allergen immunotherapy in prescribing physicians office or institution, including provision of allergenic extract; single injection) for single injections and 95125 (Professional services for allergen immunotherapy in prescribing physicians office or institution, including provision of allergenic extract; 2 or more injections) for two or more injections.

Note that you have to report the E/M services provided with a suitable 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. Don't forget to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other Service) to the E/M code to show that your physician provided more services than just the observation of the patient after providing the injection.