Allergies and allergic asthma have been on the upswing among children. But the most commonly used codes (95115, 95117) don't pay well enough unless an office visit can be billed as well, many groups feel.
For physicians who provide antigens -- mainly allergists -- report CPT 95165 (professional services for the supervision and provision of antigens for allergen immunotherapy; single or multiple antigens [specify number of doses]) for providing the dose. Bill this code by units. If you don't mix the antigens -- and most pediatricians don't -- use 95115 (professional services for allergen immunotherapy not including provision of allergenic extracts; single injection) or 95117 (... two or more injections). You cannot bill for storing the antigens.
Allergy Introduction and Office Visit Billing
You may not bill an office visit when providing allergy shots unless you provide a separately identifiable and significant service, says Paula Ziemski, CPC, coding and compliance educator at the University of Pittsburgh Medical Center in Pennsylvania. "You need to do something extra to bill an office visit," Ziemski says. "In general we tell our pediatric practices they can't do it when they give allergy shots."
Carel Martin, CPC, insurance supervisor for Cle Elum Family Medicine in Cle Elum, Wash., notes that many commercial payers follow national Correct Coding Initiative (CCI) edits and bundle most E/M services with 95115 and 95117. "You can't bill an office visit code with these companies," she says. She believes it's inappropriate to bill an E/M service with 95115 or 95117 unless the patient comes in for another problem altogether. "It's all built in to the allergy injection codes."
Some pediatric practices have stopped giving allergy shots because the remuneration is so little compared to the time expended.
"A lot of patients now provide their own serum," notes Brenda Mason, billing manager for Northpoint Pediatrics in Indianapolis. And when patients bring in their own serum it becomes too costly to give the shots because 95115 and 95117 pay so little. These codes are no longer on Mason's superbills. Because the group could not bill an office visit with the allergy injections, she says it was simply too expensive to provide allergy shots.
E/M May Be Warranted
CPT does not specify that the additional service be either significant or separately identifiable. Rather, CPT's introduction to the allergen immunotherapy codes states, "Office visit codes may be used in addition to allergen immunotherapy if other identifiable services are provided at that time" [emphasis added].
Charles Scott, MD, FAAP, a practicing pediatrician at Medford Pediatric & Adolescent Medicine in Medford, N.J., interprets the descriptor literally. [...]