Wiki Billing for Injection Administration Fee

[kreeves]

There has been a lot of controversary as of late as to whether we can or cannot bill for Injection Administration Fees. I wanted to bring it to all the professionals here for a roundtable - Here is our concern:

We are a Family Practice Clinic. We have several patients that come into our office with common ailements such as sinusitus, allergies, congestion, etc. After examination of the patient many of our providers give injections such as Rocephen, Decadron, etc. to treat them.

These injections occur while the patient is in the clinic and the medicine is purchased and administered by the clinic.

OUR QUESTIONS ARE: Can we bill for the medication and administration fee in these instances? If so, please explain in your prospective how you feel these fees should be properly billed.

Thank you in advance for any assistance you may be able to provide.

 

[Sandra Fender]

If the patient is in the office for an appointment and needs a shot, we apply modifer 25 on the E/M code, 96372 for the admin charge and the charge of the medication. We give some of the same meds as you do.

Hope this helps.
sandi

 

[airart]

Family Practice and Injections

I found this article for you to review with. The article is on Family Practice and Allergy Injection billing. Hope it helps.

Allergy injections for Family Practice Management

Q:
What code should our hospital-based clinic submit for an allergy injection when we provide the antigen? What about when an outpatient pharmacy provides the antigen to us?

A
When your clinic provides and administers the allergenic extract (i.e., antigen), you should submit 95120 or 95125 for “professional services for allergen immunotherapy in prescribing physician's office or institution, including provision of allergenic extract,” depending on the number of injections given. These codes describe the entire service of preparing, providing and administering the antigen at a single patient encounter.

If an outpatient pharmacy provides the antigen to the patient, who brings it to your clinic for administration, you should submit 95115 or 95117 for “professional services for allergen immunotherapy not including provision of allergenic extracts,” again depending on the number of injections given. These codes reflect the administration (i.e., injection) of the antigen; they do not include the provision or preparation of it.

Note: that Medicare requires you to bill only the component codes; it does not accept the complete allergy codes 95120 and 95125. If you provide the complete service (i.e., preparation and administration of the antigen) to a Medicare patient, you should submit the appropriate codes that represent the antigens and their preparation (95144–95170) in addition to the administration code (95115 or 95117).

Kent Moore is the AAFP's manager for health care financing and delivery systems and is a contributing editor to Family Practice Management. These questions and answers were reviewed by members of the FPM Coding & Documentation Review Panel, which includes: Robert H. Bosl, MD, FAAFP; Marie Felger, CPC; Thomas A. Felger, MD, DABFP, CMCM; David Filipi, MD, MBA, and the Coding and Compliance Department of Physicians Clinic; Lynn Handy, CPC, LPN; Emily Hill, PA-C; Joy Newby, LPN, CPC; P. Lynn Sallings, CPC; and Susan Welsh, CPC.

Conflicts of interest: none reported.

Editor's note: While this department represents our best efforts to provide accurate information and useful advice, we cannot guarantee that third-party payers will accept the coding and documentation recommended. Because CPT and ICD-9 codes change annually, you should refer to the current CPT and ICD-9 manuals and the “Documentation Guidelines for Evaluation and Management Services” for the most detailed and up-to-date information.

 

[overnluv@yahoo.com]

Allergy Shots Reimbursement 95117

I am a responsible for doing the billing and coding in a primary care physician's office. For Rocephin, Solumedrol, Toradol and any other medications, I code them separately from the office visit with mod-25... (96372 and the J code for the medication)

My concern is that I have been told by my senior to bill allergy shots w/ 96372 and the quantity of the shots. For example, we have a patient who gets 3 allergy shots so I bill her 96372 x3.

I have been doing this for more than 2 years now and I had only figured out that the correct code for allergy shots is 95115 and 95117. What I am concerned about is the reimbursement. Does anybody know how much the reimbursement for 95117 is? Please let me know. Thank You!

Denielle C.

 

[mitchellde]

you definitily need to bill the allergy shots with the allergy admin codes not the 96372. Regardless of the reimbursement amount. You cannot let the amount of reimbursement lure you into using incorrect codes.

 

[vramirez]

Allergy Shots/Administration

I disagree with those stating 96372 should be the administration code billed for allergy injections. Allergy injections have their own set of codes. 95115 and 95117 is the administration of the allergen. This code should be used when the allergen vial was brought into the office by the patient for administration or the allergen has already been billed. 95120 and 95125 is the code for administration of the allergen and the substance/allergen.