Primary Care Coding Alert

Question: An 18-year-old patient with a severe seafood allergy reports to the FP for an allergy injection. The practice's non-physician practitioner performs a pair of injections, and then observes the patient for 5 minutes after the injections to be sure he is OK. Seeing that the patient is having no adverse reactions to the injections, the NPP sends the patient home with instructions to call the practice if he feels any lingering post-injection symptoms. I know I can code for the injection, but is there an E/M code opportunity here, too?

Indiana Subscriber

Answer: You'd be better off eschewing the E/M code in this instance. On the claim, report 95117 (Professional services for allergen immunotherapy not including provision of allergenic extracts; 2 or more injections) for the encounter with V07.1 (Need for isolation and other prophylactic measures; desensitization to allergens) to represent the purpose of the visit and V15.04 (Other personal history presenting hazards to health; allergy to seafood) appended to represent the patient's allergy.

The monitoring and counseling the NPP provides the patient in this case is bundled into the 95117 package.

Exception: If the NPP provides a significant, separately identifiable E/M service during the session, then you might be able to report an E/M code with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended.

For instance, if the patient experiences some nausea and vomiting (787.01, Nausea with vomiting) after the injection, and the NPP needs to provide monitoring and treatment, you might be able to report an E/M-25 and 95117.

Information for and answers to You Be the Coder and Reader Questions reviewed by Kent Moore, manager of health care financing and delivery systems for the American Academy of Family Physicians in Leawood, Kan.