EM Coding Alert

Question: My physicians have just started seeing patients for allergy shots. They want to bill an E/M service for the time they spend before the injection getting the patient to sign the consent form and the time they spend after the injections when they check to be sure the patient will not have an allergic reaction. I don’t feel we can bill a separate E/M code. Am I wrong? 

Ohio Subscriber

Answer: You are not wrong given the scenario you present. You cannot bill for paperwork completion in addition to the service provided. Talking about risks and benefits of an injection also does not warrant the additional coding.

Here’s why: The allergy administration codes include a pre-procedure evaluation to ensure that the patient is able to receive the injection and a post-procedure evaluation period to determine if the patient is in jeopardy of an allergic reaction, so you cannot report an E/M code unless a significant, separately identifiable service is performed. Obtaining informed consent is also included in the immunotherapy.

There are times when billing a separate E/M service might be appropriate, however. You can report an appropriate E/M code (such as 99212-99215, Office or other outpatient visit for the evaluation and management of an established patient...), depending on the level of E/M services provided, when a separate service is performed in addition to the allergy immunotherapy.

Add 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 help the payer know that a separate service has been performed in addition to the allergy immunotherapy. Include documentation of the separately identifiable service that has been performed.

Example: Your physician assesses an established patient suffering from severe pain and fever due to a peritonsillar abscess (475), and the patient receives her scheduled bimonthly injection of allergy immunotherapy for allergic rhinitis due to animal dander (477.2). Your physician performs and documents a level-three E/M service. You should report 99115 and 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components... Typically spend 15 minutes face-to-face with the patient and/or family) along with the modifier 25 appended to 99213.