Primary Care Coding Alert

Question: When a patient comes in for allergy injections -- and that's all the nurse sees the patient for -- what is the proper billing procedure? I am suggesting CPT 95117 . Should we also use 99211?

Iowa Subscriber

Answer: You should report 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 multiple allergen injections (95117, Professional services for allergen immunotherapy not including provision of allergenic extracts; 2 or more injections) if the nurse performs a minimal E/M service related to the immunotherapy. Providers may bill for a nurse-only 99211 when dealing with clinical issues surrounding allergy injection administration, according to the Joint Council of Allergy, Asthma and Immunology (JCAAI).

The nurse must document the medically necessary E/M service that she provided. The JCAAI suggests the service could represent directing a nurse who gives injections on what to do if a patient:

- was ill

- missed an injection

- had a large, local reaction or mild unreported systemic symptoms after his last injection.

Be careful: Do not consider the required post-injection observation sufficient reason for reporting 99211. "Codes 95115-95199 include the professional services necessary for allergen immunotherapy," according to CPT's Allergen Immunotherapy instructions. CPT goes on to state, "Office visit codes may be used in addition to allergen immunotherapy if other identifiable services are provided at that time."

You do not technically need modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) on 99211 with 95115 for single injection or 95117 for multiple injections. When you bill 99211 for providing clinical advice related to the injection, modifier 25 is unnecessary and does not apply, the JCAAI says.