Pediatric Coding Alert

A parent brings allergy serum to our office. The patient comes in once every two weeks for a nurse to administer her allergy injections from the serum the parent left with us. Codes 95115 and CPT 95117 indicate professional services for allergen immunotherapy. Does that mean the physician has to inject the serum? If so, which CPT^® code do we charge?

Answer:

No, the phrase "professional services for allergen immunotherapy" refers to the work value for administering the injection (95115 or 95117). "These services are typically performed by a nurse and do not include physician work," notes CPT^® Assistant Dec. 2007. If the physician also prescribes the allergen immunotherapy and makes up the allergenic extracts, 95120-95134 would be appropriate for "professional services for allergen immunotherapy in prescribing physician's office or institution, including provision of allergenic extract."

In pediatrics, a patient may initially see an allergist who performs allergy testing, diagnoses the patient's allergies, prescribes allergen immunotherapy, and then supervises the serum preparation (95144-95170). The patient can then receive the regular injections from her pediatrician. But the pediatrician is providing the professional services (the administration) and not the allergen immunotherapy prescribing and antigen provisioning (the serum), so you use the codes that represent only allergen immunotherapy administration (95115 or 95117) as follows:

If the patient receives one injection, use 95115 (Professional services for allergen immunotherapy not including provision of allergenic extracts; single injection).

For administration of two or more allergy injections, assign 95117, which represents "2 or more injections." Because the code's descriptor indicates "injections" plural, you report 95117 with one unit, regardless of how many injections the patient receives. You would not code 95115 in addition to 95117.