Otolaryngology Coding Alert

Question: We bill all allergy injections and antigen preparation Medicare's way (component) and get paid for the procedures. Should we continue to report the services this way unless an insurer tells us to use the individual codes? If a payer doesn't say to follow Medicare's rules, is it technically more accurate to assign the individual codes? Also, since Medicare lists no relative value units for 95120-95125, how can we determine an appropriate charge for these codes?
 
Texas Subscriber Answer: If insurers reimburse you for the injections with the component codes (95115, Professional services for allergen immunotherapy not including provision of allergenic extracts; single injection; 95117, ... two or more injections; and 95144-95170, Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy ...) and don't direct you to use the complete-services codes (95120-95134, Professional services for allergen immunotherapy in prescribing physician's office or institution, including provision of allergenic extract ...), you may continue to bill "Medicare's" way. If a payer instructs you to bill a certain way, the payer's guidelines supersede Medicare's.

Let's say your office prepares antigens and administers an injection to a patient whose third-party insurer requires you to use complete-services codes. In this case, you should bill 95120 (... single injection) for immunotherapy provisioning and administration.

For 95120, you should report 0.68 relative value units. This is the same value that you would assign if you billed the component codes 95115 (0.41 RVUs) and 95165 (Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single or multiple antigens [specify number of doses]) (0.27 units).