Reimbursement Tips for Allergy Injections and Supplies
Published on Thu Jul 01, 1999
Otolaryngologists frequently place patients suffering from allergies on injection programs. If the otolaryngologist gives the shots, he or she is likely to do the allergy testing, which also includes preparing shots that normally are injected twice a week into the patient in small doses until the body builds up a resistance to them.
Sometimes, however, the specialist who tested for the allergies is located far from the patient, making two visits a week for injections quite inconvenient.
So, some patients may arrange to use other physicians closer to their workplace, or even perform the injections themselves, following an early stage in the physicians office that determines that no adverse reactions to the shots have occurred. Typically, patients would take the first five or six shots in the otolaryngologists office before injecting themselves at home.
Depending on the circumstances, the otolaryngologist may have tested the patient for allergies, prepared antigens that the patient self-injects, delivered the injections to the patient in the ENT office, or any combination of the above.
The fact that the physician who prepares the antigens for the allergy shots may not end up doing the injections is one reason why so many codes are required for billing and reimbursement in the treatment of allergies, says Susan Callaway Stradley, CPC, CCS-P, a consultant in the medical division of Elliott, Davis & Co., a healthcare accounting firm in Augusta, GA.
Coding for Injection Administration
Both 95115 (professional services for allergen immunotherapy not including provision of allergenic extracts; single injection) and 95117 (two or more injections) should be used by any physician who gives an injection to a patient from a vial of material that was prepared at another time or at another location, says Stradley, who was recently named the 1998 Coder of the Year by the American Academy of Professional Coders.
Codes 95115 or 95117 should be used even if the material was made by the same physician who administers the injection, but comes from a vial previously prepared especially for that patient.
Another example of when 95115 or 95117 should be used is if the patient decides to go to another physicians office for the pre-prepared injections.
Coding Both Material and Injection
The next series of codes, 95120-95133 (see box in next column for definitions), should be used when the physician actually draws up each individual shot separately.
The doctor has a board with as many as 300 different vials of antigens (for roaches, dust mites, etc.). Each patient has an injection schedule in their chart, and each individual antigen is mixed when the patient arrives so that the physician has more control over the doses the patient receives by means of titrating dosages, that is, modifying doses in tiny increments.
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