Oncology & Hematology Coding Alert

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.
Question: We have a patient who brings her own allergy medication, and our nurse injects it. Can we charge for a nurse-only visit (99211) and administration/injection (90780) even though we are not the patient's allergist? Also, which diagnosis code should we use?

Ohio Subscriber

Answer: You cannot bill for the E/M and procedure code if the purpose of the visit is the injection. In your case, you may have a problem billing for the injection because you did not provide the medication, which also means you cannot bill for the medication. The most appropriate coding option would be 99211 (office or other outpatient visit). 
 
The diagnosis depends on the reason the patient is visiting you. If the patient presents because of a cancer diagnosis and the allergy is secondary, the cancer diagnosis is the primary reason the patient is under your care, so list the appropriate neoplasm code (140-239.9) and then the allergy code.  
 
Allergy codes depend on type of allergy. For example, allergic rhinitis is 477. The definition provided is true immunoglobulin E (IgE)-mediated allergic reaction of nasal mucosa; seasonal (typical hay fever) or perennial (year-round allergens: dust, food, dander.) The choices are 477.0 (... due to pollen), 477.1 (... due to food), 477.8 (... due to other allergen), and 477.9 (... cause unspecified).