Pulmonology Coding Alert

Deciphering the complex rules regarding billing for allergy immunotherapy can be painful for many coders, but it is necessary that you understand when and how to separate the injection-only codes from the codes representing the antigen and its preparation.

Once you learn these simple rules, you will be able to receive proper reimbursement for your injection procedures and know when to bill for E/M visits in addition to your injection services. The Intricacies of Immunotherapy Coding CPT defines immunotherapy as the "parenteral administration of allergenic extracts as antigens at periodic intervals, usually on an increasing dosage scale, to a dose that is maintained as maintenance therapy." It is vital that you understand the difference between the two main sets of codes that will affect your billing: 95115 (Professional services for allergen immunotherapy not including provision of allergenic extracts; single injection) and 95117 (two or more injections) represent the injection service, and these codes are to be reported only one time, regardless of the number of injections given. 95144 (Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single dose vial[s] [specify number of vials]) and 95165 (Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single or multiple antigens [specify number of doses]) represent the supervision and provision of the antigens. Do not use codes 95120-95134 (Professional services for allergen immunotherapy in prescribing physician's office or institution, including provision of allergenic extract; ...), since they represent complete services that include both the injection and its preparation.

If the physician prepares the antigen and administers one injection, it is proper to code 95115, along with 95165. Use code 95144 only when the physician is providing the antigen to be injected by another physician. According to Karen Jernigan, CPC, CMIS, office manager at the Asthma, Allergy, and Immunology Clinic, James Island, S.C., "95144 is not favorable with insurance companies or physicians because it is very costly." The Medicare Carriers Manual states that a single-dose vial should be used only as a way to ensure proper dosage amounts for injections. CMS assumes that pulmonologists are capable of administering proper doses from the less expensive multiple-dose vials. Even when a physician bills 95144, he is paid at the multiple-dose-vial (95165) rate.

The fee schedule amounts for codes 95144-95170 (Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy ...) are for single doses. You must specify the number of doses provided. For example, a physician prepares a 10-dose multivial and administers one injection to the patient. You need two codes: 95165 x 10 (placed in the units box) 95115. Sometimes, the patient's doses are adjusted. If a patient has an [...]