Pediatric Coding Alert

Question: Should I report CPT 99211 in addition to 95115 if the nurse monitors an allergy injection, or does 95115 include the monitoring?

Answer: Coding experts disagree on what 95115 (Professional services for allergen immunotherapy not including provision of allergenic extracts; single injection) includes. Many allergy coders don't recommend reporting a nurse visit with the injection administration. Because it is medically necessary to monitor a patient for an adverse reaction after a shot, these coders reason that monitoring is inherent in the procedure. To bill 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician ...) in addition to 95115, these experts say that the nurse should provide a different service, such as taking the patient's vitals or history.

Other coders contend that 95115 doesn't include the monitoring. They point to CPT's 99211 clinical example of "an office visit for a 20-year-old female established patient, who receives an allergy vaccine injection and is observed for a reaction by the nurse." In addition, CPT's allergen immunotherapy notes state that you may report an  office visit in addition to allergen immunotherapy if staff provides other identifiable services. CPT doesn't specify that these services be significant and separately identifiable. Your best bet is to check with local payers and write an office 95115 monitoring policy.