Pulmonology Coding Alert

Question: How can we get paid for two or more allergy injections (each different medications) with the CPT 95125 and 95117 with the requirement to bill as one unit? The code definition says two or more injections.

New Jersey Subscriber

Answer: Not all codes in the allergy section (95004-95199) of the CPT manual are recognized or paid by insurance carriers. This is because a 1995 Medicare decision no longer allows billing a bundled service for allergy immunotherapy. Now, allergists must list each service separately. The Health Care Financing Administration only recognizes 95115 (professional services for allergen immunotherapy not including provision of allergenic extracts; one injection) and 95117 (professional services for allergen immunotherapy not including provision of allergenic extracts; two or more injections) and/or the codes representing antigens and their preparation (95144-95170).

This means that if your allergist provides both the injection and the antigen or prepared the antigen, you must select one code for the injection, and one code from 95144 through 95170 for the antigen. Medicare believes that an allergist preparing antigens should have multiple dose vials available. Therefore, if you bill 95144 (professional services for the supervision and provision of antigens for allergen immunotherapy, single or multiple antigens single dose vials[specify number of vials]), the carrier is going to change the code to 95165 (professional services for the supervision and provision of antigens for allergen immunotherapy, single or multiple antigens [specify number of doses]) for payment.

You must specify the number of doses provided in the multiple dose vial. Medicare pays for 95144 only when the antigen is prepared for injection by some other entity. Remember, the fee schedule amounts for the antigen codes (95144-95170) are single dose. When billing those codes, physicians should specify the number of doses provided. When the carrier pays the claim, HCFA has instructed it to multiply the fee schedule amount by the number of doses specified in the units field.

This means you should bill 95117 and 95144 times two units, but dont be surprised if carriers change 95144 to 95165 for payment.

Answers toReader Questions provided by: Susan Callaway-Stradley, CPC, CCS-P, an independent coding consultant and educator in North Augusta, S.C.; Andrea Lamb, CPC, billing clerk for St. Josephs Medical Plaza, a multispecialty group practice in Buckhannon, W.Va., and; Cynthia DeVries, RN, BSN, CPC, coding and reimbursement coordinator for Lee Physicians Group, a 140-provider, multispecialty practice in Fort Myers, Fla.