Primary Care Coding Alert

Family practice coders turning to the allergen immunotherapy section of the CPT manual often express frustration with the long list of codes that may be assigned to patients receiving allergy shots. This portion of the manual encompasses codes 95115-95199, with descriptions so similar that coders may be unclear about which code to report. Once a coder understands the rationale for the codes and which are considered payable, it becomes more clear when each is used, says Cynthia DeVries, RN, BSN, CPC, a coding and reimbursement coordinator for Lee Physicians Group, a 140-provider multispecialty practice in Fort Myers, Fla.

It seems like there are too many codes to choose from, she contends. But, in reality, many are not recognized or paid by insurance carriers.

The multitude of codes is a result of a 1995 Health Care Financing Administration (HCFA) decision to unbundle allergen immunotherapy services, which specifically affects codes 99115-99170, DeVries adds. Previously, coders would use one code to report both the preparation of the allergy serum and the administration of the injection. Now, however, physicians and coders must list each service separately, giving practices more reimbursement opportunities.

Coding Allergen Immunotherapy Injections

When HCFA unbundled the allergy codes five years ago, it assigned just two codes for injection services:

95115 professional services for allergen immunotherapy not including provision of allergenic extracts; single injection; and

95117 professional services for allergen immunotherapy not including provision of allergenic extracts; two or more injections.

These two codes should be reported for the injection only and do not include the extracts, points out Laura Pettigrew, RHIA, CPC, CCS-P, a training and auditing coordinator for Methodist Medical Group, which provides coding services to 96 physicians in the Indianapolis area. These codes would be assigned in cases where a patient has seen an allergist who makes up the antigen, prepares the vials and provides the antigen to the family practice for injection. Coders for the family physician would assign 95115 for one shot or 95117 for multiple shots.

Note: Many family physicians require that they see the patient at least one time prior to administering allergy immunotherapy to document the need for the shots.

Besides reimbursement for the injection itself, DeVries adds, these two codes include 30 minutes of nurse time to monitor for a reaction. Even though a patient may have received an uneventful allergy shot hundreds of times before, he or she suddenly may develop a reaction. It is imperative that a patient is monitored after each injection and these codes take that time into consideration.

Practices would not add an evaluation and management (E/M) code to the patients visit, Pettigrew notes. Although a physician must be on-site when a patient receives an allergy injection, you [...]