Pulmonology Coding Alert

Question: Can I bill allergy immunotherapy and an office visit separately?

Massachusetts Subscriber

Answer: CPT states that you can report an E/M service with 95115 (Professional services for allergen immunotherapy not including provision of allergenic extracts; single injection) only if your physician performs the office visit, such as 99213 (... established patient), separately from the injection. But if the patient presents specifically for the immunotherapy injections, you should not report a separate E/M code.
 
Suppose your pulmonologist's patient has asthma, for example, and your physician administers allergy shots to prevent exacerbation (493.02). During the visit, your physician discusses prescription management, such as bronchodilator therapy adjustments for increased wheezing episodes (786.07). You should report 99213 along with diagnosis codes 786.07 and V58.69 (Long-term [current] use of other medications) as the primary diagnosis, and 493.xx (Asthma) as the secondary diagnosis. Link 493.xx to 95115, and make sure your pulmonologist's documentation shows that the injection and office visit were separate services. Your physician should note the discussion and details of prescription management.