Pulmonology Coding Alert

Answer: Some of the CPT allergen-immunotherapy section codes are not recognized or paid by insurance carriers. Some denials result from Medicares 1995 decision that allergen immunotherapy no longer could be billed as a bundled service. Allergists now must list each service separately. The Health Care Financing Administration (HCFA) only recognizes CPT codes 95115 (professional services for allergen immunotherapy not including provision of allergenic extract; single injection) and 95117 (two or more injections), or 95144 (professional services for the supervision and provision of antigens for allergen immunotherapy, single or multiple antigens, single dose vials [specify number of vials]) through 95170 (whole body extract of biting insect or other arthropod [specify number of doses]), the codes representing antigens and their preparation.

If your allergist provides both the injection and the antigen or prepared the antigen, you must select one code for the injection and one code from 95144-95170 for the antigen.

Medicare requires that an allergist preparing antigens have multiple-dose vials available. Its advisable to bill 95165 instead of 95144 because you dont want to appear to be attempting to unbundle the services. You also dont want a carrier to reimburse only for the lower-paid service. You need to specify the number of doses in the vial.

Medicare pays for code 95144 only when the antigen is prepared for injection by another entity. Remember the fee schedule amounts for the antigen codes (95144-95170) are for a single dose. When billing these codes, physicians should specify the number of doses provided. HCFA has instructed carriers to multiply the fee schedule amount by the number of doses specified in the units field. You would therefore report code 95117, and then code 95144 x 2 units.

Editors note: Cynthia DeVries, RN, BSN, CPC, a coding coordinator with the Lee Physician Group, a 42-physician practice in Ft. Myers, Fla., answered You Be the Coder.