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Answer: If you do not provide the antigen, bill 95115 (professional services for allergen immunotherapy not including provision of allergenic extracts; single injection) or CPT 95117 ( two or more injections). Under the Correct Coding Initiative (CCI), E/M services are bundled with 95115 and 95117, so insurance plans that follow CCI edits do not allow an office visit unless a separate and distinct service is provided. Append modifier -25 (significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) to the E/M code.
Bear in mind, however, that as a pediatrician with non-Medicare patients you do not technically, at least have to follow CCI edits. For example, if a nurse administers the shot and evaluates the patient before and after for an unrelated problem, such as a fever, bill 99211 (established patient office or other outpatient visit) in addition to 95115 or 95117. Do not bill the nurse visit unless the nurse evaluates the patient for some reason other than the allergy shot.
It's really up to the payer's own policy: Some bundle E/Ms, including 99211, with 95115 and 95117 and require modifier -25 to unbundle them; some don't allow unbundling even with modifier -25; and some allow both code sets to be billed. |
