Pulmonology Coding Alert

Question: We are having problems getting reimbursed for allergy injections for stinging insect venoms. Our physician prepared 3 doses of a vespid mix (white and yellow hornets and yellow jackets) and a honey bee venom (3 doses). Should we bill the same for these injections as for the other allergy immunotherapy injections?

Colorado Subscriber

Answer: Coding for stinging insect venom is slightly different from coding for administration of other antigens. First, you need to understand the unique codes for insect venoms and crosscheck them with your physician’s notes. You should select from the 95145-95149 code family for the insect venom to represent the antigen itself, its preparation, and the physician’s determination of concentration and volume required for the planned schedule of injections based on skin testing and patient history. Administration of injections is not included in these codes.

You should also use from codes 95115-95117 (Professional services for allergen immunotherapy not including provision of allergenic extracts;…) that describe the professional service of administration of allergenic extract – the injection itself – but do not include the actual supply of the allergenic extract that is given.

You should code the insect antigen doses provided above as:

• 95148 (…4 single stinging insect venoms) 3 doses
• 95115 or 95117 (Professional services for allergen immunotherapy not including provision of allergenic extracts; 2 or more injections) – depending on the number of separate injections provided at the time of administration of the injections

The main problem regarding these codes is that you must be aware of the number of stinging insect venoms for which you are billing. When you bill for venoms, the number of insects and the number of doses is important. This is different from the allergen antigens in which it is not relevant how many antigens are in the vial. It does not matter whether the doses come from the same multiple-dose vial or a series of vials, because the code describes the dose, not the bottle.

If the antigen is prepared from the whole body of the insect, then the code 95147 will change to 95170 (Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; whole body extract of biting insect or other arthropod [specify number of doses]).