Pulmonology Coding Alert

Question: When our physician prepares 36 doses of three stinging insect venoms on the same day as 24 doses of two (different) stinging insect venoms, should we code 95147 with 95146-59? Or, would it be more appropriate to have the physician prepare 24 doses for all five, reporting 95149, then later prepare a "catch-up" vial for three stinging insect venoms? We've not been getting paid for 95146-59, even after filing an appeal showing the different units.

Wisconsin Subscriber

Answer: If the same patient is receiving five-venom dose therapy, you should report the five-venom code for the number of doses your physician prepares. In other words, you should report 95149 (Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy [specify number of doses]; five single stinging insect venoms).
 
The Medicare Carriers Manual explains that "a dose of code 95146 (the two-venom code) means getting some of two venoms. Similarly, a dose of code 95147 means getting some of three venoms; a dose of code 95148 means getting some of four venoms; and a dose of 95149 means getting some of five venoms."
 
You can review Medicare's examples of venom injection coding at www.cms.hhs.gov/manuals/downloads/clm104c12.pdf.