Pulmonology Coding Alert

Question: My pulmonologist assessed a patient suffering from severe pain and fever due to a peritonsillar abscess and the patient received her scheduled bimonthly series of allergy immunotherapy for allergic rhinitis due to dander. What would I report?

Texas Subscriber 

Answer: You can report 95115 (Professional services for allergen immunotherapy not including provision of allergenic extracts; single injection) and an E/M service from the 99211-99215 (Office or other outpatient visit for the evaluation and management of an established patient…) range. You should attach modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to the E/M code to indicate that the E/M service was separately identifiable from the injection. 

Since your pulmonologist evaluated and managed the patient for a problem that was not in any way related to the allergy immunotherapy, you are justified in using a modifier to separately report the codes with compensation for both the codes.

When the pulmonologist provides one injection for immunotherapy, you should assign code 95115. For two or more shots during the same session, use code 95117 (… two or more injections). Remember that you can report only one code per session.

You should use code 95144 (Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy, single-dose vial[s] [specify number of vials]) or 95165 (… single or multiple antigens [specify number of doses]) when the pulmonologist supervises and provides antigens. Again, you’ll choose the appropriate supervision codes based on the number of vials or doses. For example, to report the physician’s injection and preparation/provision, use 95115 and 95165 (with the number of doses that have been prepared for the vial). For multiple injections, assign 95117 and 95165. In both cases, identify the number of doses, coding experts say.

Diagnosis help: For the abscess, report J36 (Peritonsillar abscess) and for the allergy immunotherapy report J30.81 (Allergic rhinitis, due to animal [cat] [dog] hair and dander).