Ah-Choo! Coding for Allergy Injections

March 21st, 2012

If a patient presents at your office for an allergy injection, don't forget to capture all billable charges.

Per CPT 2012, Allergy Immunotherapy Codes 95115 through 95117 "include the professional services necessary for allergen immunotherapy.  Office visit codes may be used in addition to allergen immunotherapy if other identifiable services are provided at that time."

In addition to code 95115 (Professional services for allergen immunotherapy not including provision of allergenic extracts; single injection) or 95117 (… two or more injections), remember to include the code for the vaccine if provided by you. 

In appropriate cases, you may also bill for an office visit.

An example from Family Practice Coding Alert:

An FP sees a patient due to nasal congestion (478.19), and then the patient receives her scheduled bimonthly series of two allergy injections for allergic rhinitis due to pollen (477.0). The physician performs and documents a level-two E/M service. You may report 99212 and 95117, according to Medicare rules.

According to the Correct Coding Initiative, a modifier is not needed to code both codes.

In appropriate cases, you may even bill 99211, other staff services, with an allergy injection.  Just be sure the reason for the evaluation and management services is well documented.  Examples could include:

  • The patient was running a fever; and the staff member queried about other symptoms.
  • The patient complained about dermatitis or soreness after the least injection; and the staff member shared known reactions to the injection.
  • The patient had not been following the set schedule for injetions; and the staff member investigated why.

Although modifiers have not been required according to CCI edits since 2008, some private insurance companies do not follow standard edits.  In those cases you may need to append modifier 25 to the evaluation and management code.

In all cases, be sure to use accurate diagnosis linking.

Tags: Allergy Injections


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