Primary Care Coding Alert

 Question: Our practice started offering allergen immunotherapy. The nurse explained, -We have ordered multi-dose vials for injections. There are about 15 bottles of allergy shots. Injections are made from these bottles. We are mixing according to the doctor's recipe; we have empty bottles and human albumin serum for mixing.- For allergy injections, the nurse documented in a patient's chart:
 - injected vial A green 1:1,000 = 1.0 ml sq.
 - injected vial B green 1:1,000 = 1.0 ml sq.
 How should I code for the vials and the administration?

Colorado Subscriber


 Answer: For the extract preparation, you should bill 95165 (Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single or multiple antigens [specify number of doses]). Use units to report the specific number of doses.

 CPT interprets a dose as equivalent to the amount of serum the nurse draws up in the injection. For instance, if a nurse mixes serum in a multi-use vial containing 10 doses, you should enter a -10- in the units box following 95165.

 Medicare requires direct supervision for antigen preparation. So based on CMS- incident-to rules when a nurse provides this service, a physician must be in the office suite.

 Best bet: Check major payers- incident-to requirements before mixing serums outside FP hours, such as on Saturdays or early mornings. Otherwise, you may not be able to charge for extract preparation due to not meeting incident-to criteria. 

 Next step: Report the administration with 95117 (Professional services for allergen immunotherapy not including provision of allergenic extracts; two or more injections). Because the nurse administered two injections, 95117 is the appropriate code. When she administers one injection, use 95115 (... single injection).

 Take-away tip: You may bill 95165 and 95117 on different days for the same patient. Offices usually prepare multi-dose vials on a weekly basis, which is when you should report the substance provision.

 Then, you should code the administration when the patient receives his shots.