Pulmonology Coding Alert

Question: Some asthmatic patients bring their allergy injection preparation for us to administer and then we monitor them for asthmatic symptoms postinjection. If the physician does not see the patient, how should we bill these injections? How should we code the visit if the physician evaluates the patient for wheezing following the allergy shot?

South Carolina Subscriber

Answer: Because the pulmonologist is not preparing the allergen extract, you should bill only for the injections (95115 for a single injection and 95117 for more than one). The ICD-9 code should represent the reason the patient is receiving the allergy injection(s). For example, an asthmatic patient may receive an injection to reduce exacerbations from external triggers. Therefore, asthma is reported as the reason for the injection (e.g., 493.00).

The physician does not have to physically see the patient to bill for this service. The injection can be provided by a healthcare professional in the physician's office who is qualified to do so. The physician should be available, however, if the patient experiences an adverse reaction from the injection, such as wheezing. In this case, the physician cannot report the evaluation separately unless the condition warrants additional work (history, exam and decision-making) beyond the monitoring/evaluation associated with the allergen injection. If these requirements are met, an E/M code (99201-99215) can be reported with modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) for wheezing (786.07) in addition to the allergen injection (95115-95117) for asthma (493.xx).

Answers for You Be the Coder and Reader Questions were provided by Mary Mulholland, RN, BS, CPC, reimbursement analyst at the University of Pennsylvania department of medicine in Philadelphia; Carol Pohlig, BSN, RN, CPC, a reimbursement analyst for the Hospital at the University of Pennsylvania in Philadelphia; Walter O'Donohue, MD, FCCP, FACP, chairman of the CPT committee of the American College of Chest Physicians (ACCP) and a representative of the American Medical Association CPT advisory committee for ACCP, Omaha, Neb.; and Antoinette M. Revel, RN, NP, CPC, principal at Healthcare Consulting Services in Warrington, Pa.