Primary Care Coding Alert

Question: May I bill 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician ...) in addition to allergy shots (95115-95117) if the nurse monitored the patient for 10 minutes after administering the shot to make sure he didnt have a bad reaction? Should I attach a modifier?

California Subscriber

Answer: You may bill E/M services in addition to 95115 (Professional services for allergen immunotherapy not including provision of allergenic extracts; single injection) and 95117 ( two or more injections) only when you provide separately identifiable services at the same time. Monitoring the patient after the injection is included in the injection procedure. It is standard care for any patient who receives an allergy injection to keep him for 20 minutes after the shot and then recheck his arms before allowing him to leave.

In addition, according to section 5202 of the Medicare Carriers Manual, "... where you know that the sole purpose of, e.g., an office visit was for the patient to receive an injection, payment may be made only for the injection (if it is covered). Allowance of a separate additional charge for an office visit would not be warranted where the services rendered did not really constitute a regular office visit."

You should also follow the CPT guideline to report the CPT code (service) that "accurately identifies the service performed," so use 95115 and 95117 instead of 99211, and do not bill 99211 in addition to the allergy injection code unless a clearly separate service is provided.

Answered by Kathy Pride, CPC, CCS-P, HIM, applications specialist with QuadraMed, a national healthcare information technology and consulting firm based in San Rafael, Calif.