Otolaryngology Coding Alert

Question: Can you bill out 94150 with 95115 and 95117? We have been receiving denials for 94150.

Indiana Subscriber

Answer: With allergy testing, it's common that the nurse or allergist may perform a vital capacity test to measure the patient's lung capacity. This procedure is coded as 94150 (Vital capacity, total [separate procedure]) and may be coded in addition to 95115 (Professional services for allergen immunotherapy not including provision of allergenic extracts; single injection) and 95117 (Professional services for allergen immunotherapy not including provision of allergenic extracts; 2 or more injections).

If this question were to have been asked in year's prior, the answer would have been that these two code sets are not billable together. That's because 94150 was formerly classified as a Status B code. According to CGS Administrators, a Medicare Administrative Contractor (MAC), "Status B codes are bundled. Payment for these services is always included in payment for other services not specified. There are no relative value units (RVUs) or payment amount for these codes, and separate payment is not made."

However, 94150 is currently a Status S code, which, according to Noridian Medicare, is a "significant procedure not subject to multiple procedure discounting."

Currently, you may bill 94150 along with 95115/17 on the same claim, but the documentation should show medical necessity. A diagnosis for a breathing problem like asthma or COPD would support 94150, while an allergy diagnosis should be linked to the allergy shot. Remember that denials often happen because the same diagnoses are being linked to multiple codes in the same order. The first diagnosis linked is always given the highest weight.