Pulmonology Coding Alert

Question: Our pulmonologist frequently sees patients who come in for allergy injections but also have other complaints. Can I bill an E/M code (99201-99215) and an injection code for these visits?

Mississippi Subscriber

Answer: You can bill for both services, but only under certain circumstances. If the pulmonologist sees the patient for a condition that is separate from the allergy injection, such as chest pains (786.50), you can code separately for the office visit. 
 
CPT stipulates that you can report an office visit in addition to allergy immunotherapy only when the physician provides other significant, separately identifiable services during the visit. This can include an examination of the patient, interval history, and the evaluation of diagnostic tests. You should append 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 appropriate E/M visit code. For example, an asthma patient comes in for an asthma management visit and receives an injection. You would append modifier -25 to the office visit code, such as 99211-25.
 
Most insurance companies bundle the injection into the E/M visit. But even in these circumstances, you should bill for the antigen supply. Ask your payer for its policy on E/M visits and allergy injections.
 
Link the appropriate diagnosis code to the office visit to indicate that the visit is for a condition unrelated to the allergy injection. For example, if the office visit focuses on prescription management for the asthma, you would use diagnosis codes V58.69 (Long-term [current] use of other medications) and 493.xx (Asthma) for the office visit, and a code from the 477.x series (Allergic rhinitis) for the allergy injection. Make sure the documentation shows that the injection is separately identifiable from the office visit. 
 
Some coding experts advise that the key to receiving reimbursement for both services is not separate diagnosis codes but appropriately documenting the significant, separately identifiable E/M service in the medical record.