Otolaryngology Coding Alert

Question: We are having problems getting reimbursed for allergy injections for stinging insect venoms. Should we bill the same for these injections as for the other allergy immunotherapy injections?

Colorado Subscriber Answer: You are facing a common problem among allergy immunotherapy coders, and there is an easy explanation for your predicament. Coding for stinging insect venom is slightly different from coding for administration of other antigens. First, you need to understand the unique codes for insect venoms:

95145 - Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy (specify number of doses); single stinging insect venom
95146 - ... two single stinging insect venoms
95147 - ... three single stinging insect venoms
95148 - ... four single stinging insect venoms
95149 - ... five single stinging insect venoms
95170 - Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; whole body extract of biting insect or other arthropod (specify number of doses). The main problem regarding these codes is that you must be aware of the number of stinging insect venoms you are billing for. When you bill for venoms, the number of insects and the number of doses is important.  This is different from allergen antigens, in which the number of antigens in the vial is not relevant. CPT specifies that these codes do not include the antigen administration.
 
If an allergist prepares five doses of an antigen containing three stinging insect venoms, the codes would be 95147 x 5 and 95117 (Professional services for allergen immunotherapy ...) for the administration of each dose at each encounter. Whether the doses come from the same multiple-dose vial or a series of vials does not matter, because the code describes the dose, not the bottle.