Pulmonology Coding Alert

When to pick 95115 over 95120 If you want to code your pulmonologist's immunotherapy treatments with confidence, you'll need to know when and how to report antigen injection and preparation services. Coding experts offer three tips to maximize your immunotherapy reimbursement. 1. Report 95115 Once per Session When the physician provides immunotherapy, you have several codes to choose from, and a few to avoid.

Codes 95115 (Professional services for allergen immunotherapy not including provision of allergenic extracts; single injection) and 95117 (... two or more injections) represent injection services. Report one code per session, depending on the number of injections the physician gave. When your pulmonologist supervises and provides antigens, use 95144 (Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single dose vial[s] [specify number of vials]) or 95165 (... single or multiple antigens [specify number of doses]). Remember not to report codes 95120-95134 (Professional services for allergen immunotherapy in prescribing physician's office or institution, including provision of allergenic extract ...) to Medicare, because these codes represent complete services that include both the injection and preparation. But Medicare wants practices to report each physician service, coding experts say. To report the physician's injection and supervision for a single injection, use 95115 and 95165. For multiple injections, assign 95117 and 95165. In both cases, identify the number of doses, coding experts say. You should report 95144 only when the physician provides the antigen for another physician to inject. Most insurance companies don't reimburse 95144, and physicians avoid using 95144 because it's too expensive, says Karen Jernigan, CPC, CMIS, office manager at the Asthma, Allergy, and Immunology Clinic, James Island, S.C. For this reason, Medicare pays 95144 claims at the 95165 rates, coding experts say. 2. Check Your Immunotherapy Documentation Once you've learned how to use immunotherapy codes, you must support them with the appropriate ICD-9 codes. Knowing how to assign diagnosis codes becomes even more important now that the HHS Office of Inspector General targets immunotherapy services in its 2004 Work Plan. The OIG states that most immunotherapy claims lack sufficient medical documentation. Suggest to the pulmonologist that he or she make clear in the patient's documentation that the patient has a year-round allergy, not just an occasional runny nose, says Susan Callaway, CPC, CCS-P, an independent coding auditor and trainer in North Augusta, S.C.

For example, the pulmonologist treats a patient for allergic rhinitis (477.x) with two immunotherapy injections. You should report 95117 and 95165 for the injections. To prove medical necessity, link 477.x as the primary condition to both 95117 and 95165. Your physician doesn't have to document the reason for immunotherapy every time he or she bills for 95165. But the physician [...]