Pulmonology Coding Alert

Question: On several occasions, an allergy patient has had an anaphylactic reaction in the office. In such cases, can we report our pulmonologist's services in addition to the allergy injection?

Texas Subscriber

Answer: Yes, you may report the physician services in addition to any applicable injection code(s), such as 95115 (Professional services for allergen immunotherapy not including provision of allergenic extracts; single injection; or 95120, Professional services for allergen immunotherapy in prescribing physician's office or institution, including provision of allergenic extract; single injection). As in other situations when your pulmonologist provides an E/M service, such as established patient visit 99214 (Office or other outpatient visit for the evaluation and management of an established patient), simultaneously with a procedure, he must 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 99214.

Generally, your physician will treat the patient with epinephrine (which you can bill using HCPCS supply code J0170) and report the appropriate E/M service, such as 99214. If your patient has a severe reaction, your pulmonologist may document and report the critical care (99291-99292) along with any other separately reportable services, such as 31500 (Intubation, endotracheal, emergency procedure) as necessary. In all cases, documentation should clearly explain the patient's condition to justify reporting the additional E/M code(s).