Pediatric Coding Alert

Question: When a patient comes into our office just for an allergy injection that is given by the medical assistant, are we allowed to also charge 99211? Also, when a patient comes into our office just for an immunization given by the medical assistant are we also allowed to charge 99211 in conjunction with 90471 and the vaccine codes?

Maryland Subscriber

Answer: Allergen immunotherapy is often confusing. Codes 95115 (professional services for allergen immunotherapy not including provision of allergenic extracts; single injection) and 95117 (two or more injections) should be used if you are not providing the allergenic extracts.

You should not use code 90782 (therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular) for allergen immunotherapy. Codes 95120 (professional services for allergen immunotherapy in prescribing physicians office or institution, including provision of allergenic extract; single injection) and 95134 (five stinging insect venoms) are to be used when the physician administering is also prescribing and providing the allergenic abstract. An evaluation and management (E/M) code should be used only if a significant, separately identifiable service is rendered. In this case, you would attach the modifier -25 to the E/M code. For example, you may bill 99211 (nurse only) or 99212 (office or other outpatient visit for the E/M of an established patient) at the time of an allergy injection if the child has a cough. In terms of vaccine administration coding, each vaccine code (90700, etc.) should be accompanied by a vaccine administration code (90471-90472). The first vaccine goes with 90471. Each subsequent vaccine is accompanied by 90472. Because the codes are now very specific, be sure to chose the proper code for the vaccines you purchase. If you change manufacturers, you may need to change codes for certain vaccines (such as HIB). Your final billing should have an equal number of vaccines and administration codes.