Pediatric Coding Alert

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answer. Question: How should I charge CPT 95165 for an immunotherapy allergen kit? We make a kit to last a year, and administer one per week. The code specifies number of doses. What code should I use to give the shot?

California Subscriber         Answer: According to the American Medical Association's CPT Changes 2002: An Insider's View, an explanatory note was added to the descriptors for 95165 (Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single or multiple antigens [specify number of doses]) and 95170 (& whole body extract of biting insect or other arthropod [specify number of doses]) "to assist in clarifying the definition of a 'dose' for allergy immunotherapy reporting." Specifically, a dose is defined as the amount of antigen administered in a single injection from a multidose vial, or drawn from a treatment board in one syringe. This replaces an earlier guideline that defined a dose as "the total amount of antigen to be administered to a patient during one treatment session, whether mixed or in separate vials."

The change in CPT follows and reinforces a "Final Rule" first published in the Nov. 1, 2000, Federal Register, which instructed physicians to bill Medicare for the total number of doses in all vials as long as the number of doses does not exceed 10 per vial. For example, if the pediatrician prepares eight 1-cc doses in a single vial, 95165 may be reported with an "8" in the units field. Previously, some payers would reimburse only one unit for each vial prepared. If the doses are administered to the patient in a series of eight injections, each injection may be reported using 95115 (Professional services for allergen immunotherapy not including provision of allergenic extracts; single injection). Similarly, 95115 and 95165 may be reported for a single "off the board" injection. When multiple antigens must be mixed in separate vials, you may bill separately for each dose prepared in each multidose vial. Code 95115 specifically excludes provision of the allergenic extract, and should not be bundled to 95165 or 95170.