You Be the Coder:
Billing Allergy Injections
Published on Sat Jan 01, 2000
Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: With allergy injections being so risky for a patient, how is it that code 95117 (professional services for allergen immunotherapy not including provision of allergenic extracts; two or more injections) should be billed with 1 entered in the units column? Some patients receive as many as five or six injections at a time, and with each injection the danger for the patient and the liability for the physician are greatly increased. The reimbursement difference for one unit from code 95115 (professional services for allergen immunotherapy not including provision of allergenic extracts; single injection) to code 95117 does not come close to covering that liability and cost to the physician, especially when there is someone on staff with the sole task of mixing antigens and giving injections. Also, my experience has been that insurance companies pay 95117 for the number of units billed, not just a flat rate for the code. Medicare and Blue Cross/Blue Shield representatives also have conflicting views regarding this code.
Anonymous Alabama Subscriber
Answer: The CPT clearly states that 95117 is for two or more shots, so no units apply. Most carriers follow this guideline, although it is possible that some third-party payers choose to reimburse allergy shots differently.
Kathy Zmuda, CPC, lead inpatient coder for Cigna Healthcare in Scottsdale, Ariz., notes that if antigens are being mixed there are separate codes that also should be billed. Unlike the allergy injection code, these codes may be billed according to the number of units, resulting in substantial reimbursement.
If all the physician is doing is billing two or more injec-tions, they should code 95117. But if they also are mixing the allergens, they can bill that in one of two waysin one lump sum or with each injection. Billing the allergens out in a lump sum (CPT codes 95145-95170) reimburses better, she adds.
For example, an otolaryngologist may need to mix multiple doses of antigens specifically for a patient who is allergic to grass and certain foods. This procedure (95165, professional services for the supervision and provision of antigens for allergen immunotherapy; single or multiple antigens [specify number of doses]) is billed out according to the number of doses mixed, not the number of antigens in the doses. If the vial contains 20 antigens and eight doses, the physician bills for eight doses. The number of doses goes in the units column when filing the claim.
These codes, along with 95144 (professional services for the supervision and provision of antigens for allergen immunotherapy, single or multiple antigens, single dose vials [specify number of vials]), should be used in conjunction with [...]
