Otolaryngology Coding Alert

Question: We will be dispensing a medication called Ragwitek to our first patient in the next few weeks. The patient will come to our office to take the pill and our allergy technician will observe him for 30 minutes (the doctor will be present in the office). If the patient tolerates the medication, we’ll give him a prescription to fill. Can we bill the 30-minute observation under the supervising physician in the office that day? Also, the pharmaceutical company recommends that we have the patient sign a consent beforehand. What would this need to include? 

North Dakota Subscriber

Answer:  It is common for trained personnel to observe a patient for 20 minutes following allergy shot administration, but you don’t bill for the observation because the service is included in the administration fee. 

The consent probably is to get the patient’s acknowledgment that he might have an adverse reaction to the medication. Check with the pharmaceutical company to ask if they had a different purpose in mind. 

You probably will not be able to bill for the pill itself. E/M code 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem[s] are minimal. Typically, 5 minutes are spent performing or supervising these services) might be appropriate. 

Take note: Even though 99211 does not require direct supervision by the physician, there must be a physician on site, in the office suite. You bill the 99211 under the physician who is present while the patient is observed, even if that is not the patient’s doctor. The doctor on site’s NPI must be the one used when billing for the incident to service. Since there is no way to bill for the pill, it is suggested that the patient be given a prescription that they fill prior to taking it in the office so that they pay for it and potentially get it covered under their prescription plan. Verify you have the appropriate documentation to submit 99211.