Pulmonology Coding Alert

Question: Can I bill allergy immunotherapy and an office visit separately?

Massachusetts Subscriber
Answer: Allergy immunotherapy is the administration of allergenic extracts as antigens at periodic intervals, usually on an increasing dosage scale, to an amount that is continued as maintenance therapy. In most cases the patient presents specifically for the immunotherapy injections, and a separate office visit cannot be billed. However, in some circumstances the immunotherapy and office visit are separate.
 
The allergen immunotherapy codes (95115-95199) state that "Office visit codes can be used in addition to allergen immunotherapy if other identifiable services are provided at that time." When you bill an office visit with any of these codes, attach modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code to indicate that it is separate.
 
If the visit consists only of the allergy shot, a separate visit should not be billed. But if the patient has asthma, for example, and is getting the allergy shots to prevent exacerbation, and you discuss prescription management (e.g., bronchodilator therapy adjustments), these are two separate managements for the same problem. Use 493.xx linked to the allergy shot code (e.g., 95115, Professional services for allergen immunotherapy not including provision of allergenic extracts; single injection), and link V58.69 (Long-term [current] use of other medications) to the office visit code as the primary diagnosis with 493.xx as the secondary. Documentation must show that the injection was separately identifiable from the office visit.