Pediatric Coding Alert

Question: A patient who requires immunotherapy due to hay fever brings in serum for his biweekly allergy injection. Which CPT Codes should I use for giving one injection and monitoring the patient?

New Hampshire Subscriber
 
Answer: Because your office provides the injection administration only, you should report 95115 (Professional services for allergen immunotherapy not including provision of allergenic extracts; single injection). This code includes providing the shot and monitoring the patient for any adverse reactions.

Don't separately report an office visit unless the nurse provides a significant, separately identifiable service (modifier -25, Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service). You can code a nurse visit (99211, Office or other outpatient visit for the evaluation and management of an established patient ...) in situations such as the following: When a child presents for his shot, he has a cough (786.2). The nurse evaluates him to make sure he is healthy enough to receive the shot and documents his temperature and respiratory rate. In this case, report 95115 and append modifier -25 to 99211 to indicate that the office visit is a documented, significant, separately identifiable service from the injection.