Pulmonology Coding Alert
Don't Always Reach to E/M During Allergy Injection Visits
Question: If a patient came to our practice to receive allergy injections that were prescheduled, can a separate E/M code be reported for the visit? If so, should a modifier 25 be appended to the E/M code?
Virginia Subscriber
Answer: If the patient came for a prescheduled visit in which only allergy injections were administered, you should look at what other services were provided during the visit to check whether you can report a separate E/M code for the encounter.
If, during the encounter, your clinician only performs a pre-procedural evaluation of the patient to ensure that the patient is stable and will have no trouble to receive the scheduled injections, you cannot report a separate E/M code for the visit. Also, any evaluation or observation of the patient after your clinician administers the injections to check if the patient has any adverse effects will not allow you to reach out for a separate E/M code.
You are allowed to report a separate E/M code for the encounter if your clinician performs an evaluation of the patient for a problem that is not pertinent to the allergy injections that were administered during the visit. For instance, the patient complains to your pulmonologist during a prescheduled allergy injection visit that he has been suffering from cough and chest pain for the past two days and your clinician evaluates and provides management of the patient’s complaints (e.g., orders a chest x-ray to determine a cause) along with providing the allergy shots.
In such a case, you will be allowed to claim a separate E/M code for the evaluation and management of this separately identifiable service. If you report an E/M code for the visit in which you are reporting the allergy shots with a CPT® code such as 95115 (Professional services for allergen immunotherapy not including provision of allergenic extracts; single injection), you have to append the modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professionalon the same day of the procedure or other service) to the E/M code to let the payer know that it is a separately identifiable service, and link the separate diagnosis codes to the two services.
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