Pulmonology Coding Alert

Correct code reporting for allergy immunotherapy hinges on understanding that physicians are to bill only for the component codes, i.e., the injection-only codes (95115 and 95117) and/or the codes representing antigens and their preparation (codes 95144-95170). Physicians providing both services should bill for both.

The CPT defines immunotherapy (desensitization, hyposensitization) as the parenteral administration of allergenic extracts as antigens at periodic intervals, usually on an increasing dosage scale to a dosage which is maintained as maintenance therapy. Understanding the differences between the following codes is critical to obtaining appropriate reimbursement for these codes:

95115-95117 professional services for allergen immunotherapy not including provision of allergenic extracts; single injection; and two or more injections,
respectively

95144 professional services for the supervision and provision of antigens for allergen immunotherapy, single or multiple antigens, single-dose vials [specify number of vials]

Editors note:Use 95144 instead of 95135 or 95140, which have been deleted in CPT 2000.

The office visit is a separate procedure, says Deanna Furman, president and CEO of MediPro Corporation, a physician billing service in North Little Rock, Ark. The patient comes in initially for the office visit [99212-99215] and scratch test. Then the serum is created [95144]. After that the patient comes back to the allergist or takes the serum to their general practitioner and keeps getting the shots how ever often they need to get them [95115 or 95117).

Know When to Use Modifier -25 and Bill for an Office Visit

The CPT reads that codes 95115 to 95199 include the professional services necessary for allergen immunotherapy. Office visit codes may be used in addition to allergen immunotherapy if other identifiable services are provided at that time. What you need to remember, says Furman, is that if youre going to bill an office visit, you have to use modifier -25 and show a separate diagnosis.

CPT modifier -25, according to CPT 2000, is a significant, separately identifiable evaluation and management service by the same physician on the same day of a procedure or other service. The modifier is attached to the E/M code and not to the service code.

A patient cant be coming in for the same thing shes getting a shot for, Furman continues. The patient has to have some other flare-up to bill an office visit. This becomes tricky when youre trying to do [the injections] the same day as the office visit. Make sure you use your modifier and separate diagnosis.

According to the American Medical Association (AMA), The physician may need [...]