Pulmonology Coding Alert

Question: We have several patients who come in for allergy injections but also have other complaints at the time of their injections. Our pulmonologist sees them. Can I report an office visit and an injection code for these visits?


Washington Subscriber
Answer: Under certain circumstances, you can report both an E/M code (99201-99215) and an injection code. If the pulmonologist sees the patient for a condition that is separate from the allergy injection, such as chest pains (786.50), you can code separately for the office visit.

CPT stipulates that you can report an office visit in addition to allergy immunotherapy only when the physician provides other significant, separately identifiable services during the visit. This includes an examination of the patient, interval history, and the management of the issues addressed.

You should append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the appropriate E/M visit code.

For example, an asthma patient comes in for an asthma management visit and receives an injection. You would append modifier 25 to the office visit code, such as 99213-25 (Office or other outpatient visit for the evaluation and management of an established patient ...). 
  
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; Alan L. Plummer, MD, professor of medicine, division of pulmonary, allergy, and critical care at Emory University School of Medicine in Atlanta; and Vicky O'Neil, CPC, CCS-P, a compliance coordinator in St. Louis, Mo.