Pulmonology Coding Alert

Question: When my physician administers two separate venoms (for example, honeybee and yellow jacket), should I code 95146 and use the total doses given or should I code for each venom (single venoms) individually (95145 times the total doses)?


North Carolina Subscriber

Answer: When reporting stinging insect venom administration, you choose your codes based on the number of different insect venoms your physician uses and the number of doses he gives the patient.

Example: If your pulmonologist prepares five doses of an antigen containing two stinging insect venoms, you would use 95146 (Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy [specify number of doses]; two single stinging insect venoms) x 5 and 95117 (Professional services for allergen immunotherapy not including provision of allergenic extracts; two or more injections) for the administration of each dose at each encounter. Use these codes regardless of whether the doses come from the same multiple-dose vial or a series of vials, because the code describes the dose, not the bottle.

The main problem you have when reporting stinging insect venom codes is that you must be aware of the number of venoms your physician administers. 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.