Otolaryngology Coding Alert

Question: A nurse administers three bee-venom injections containing five venoms. How should I report the immunotherapy service and the supply? Also, we make up the serum each time the patient presents for shots. Should I bill the serum each time or only up front when we order the venom? Michigan Subscriber Answer: You should report 95134 (Professional services for allergen immunotherapy in prescribing physician's office or institution, including provision of allergenic extract; five stinging insect venoms) x 3 units to private payers, and 95149 (Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy [specify number of doses]; five single stinging insect venoms), 95117 (Professional services for allergen immunotherapy not including provision of allergenic extracts; single injection) to Medicare. Third-party payers recognize the combination administration and antigen preparation codes, such as 95134, for off-the-board injections. Medicare, however, requires component billing. So, you have to code the administration (95117) and the antigen preparation (95149) separately. Because you prepare the antigen at each visit, you should report 95134 or 95149 per visit.