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Pulmonology Coding Alert

Reader Question:

Don't Let Venom Injections Poison Reimbursement

Published on Sat Oct 30, 2004

Question: We are having problems getting reimbursed for allergy injections for stinging insect venoms. Should we bill the same for these injections as for the other allergy immunotherapy injections?

Colorado Subscriber

Answer: You are facing a common problem that arises among allergy immunotherapy coders, and there is an easy explanation for your predicament. Coding for stinging insect venom is slightly different from coding for administration of other antigens. First, you need to understand the unique codes for insect venoms. Separate codes are used in conjunction with insect antigen doses:

  •  95145 - Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy (specify number of doses); single stinging insect venom

  •  95146 - ... two single stinging insect venoms

  •  95147 - ... three single stinging insect venoms

  •  95148 - ... four single stinging insect venoms

  •  95149 - ... five single stinging insect venoms

  •  95170 - Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; whole body extract of biting insect or other arthropod (specify number of doses).

    The main problem regarding these codes is that you must be aware of the number of stinging insect venoms you are billing for. When you bill for venoms, the number of insects and the number of doses are important. This is different from the allergen antigens, in which it is not relevant how many antigens are in the vial. CPT holds that these codes do not include the administration of the antigen.

    If a pulmonologist prepares five doses of an antigen containing three stinging insect venoms, the coding would be 95147 x 5 and 95117 (Professional services for allergen immunotherapy ...; two or more injections) for the administration of each dose at each encounter. Whether the doses come from the same multiple-dose vial or a series of vials does not matter, because the code describes the dose, not the bottle.


    - Answers for You be the Coder and Reader Questions were reviewed by Carol Pohlig, BSN, RN, CPC, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia; and Alan L. Plummer, MD, professor of medicine, Division of Pulmonary, Allergy and Critical Care at Emory University School of Medicine in Atlanta.

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