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Billing venom allergy injections with serum

Rick Posted Thu 30th of June, 2011 19:55:05 PM

When we bill for making allergy serum we are billing code 95165 and using either 95115or 95117 for the injection. When we make allergy serum for stinging insect venom, we bill codes 95145-95149 and use 95130-95134 for the injections. Is this correct?

SuperCoder Answered Tue 05th of July, 2011 05:00:22 AM

You have categorized the codes as allergy whether venom or non-venom kind of. But the Allergy immunotherapy are based on three models.
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1. Administration Only:
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Prepared allergenic extract is supplied by another health care provider (eg, the patient's allergist) and administered during a face-to-face encounter with the nurse or the physician.
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Report either 95115 or 95117 during a single patient encounter. If one injection is given, report 95115 (only). If two or more injections are given, report 95117 (only). Per CPT guidelines, "office visit codes may be used in addition to allergen immunotherapy if other identifiable services are provided at that time" (CPT 2009, Professional Edition, American Medical Association, page 425).
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2.Preparation and Provision:
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Physicians who use a "treatment board" method, where small amounts of antigen are drawn from a number of separate vials containing different strengths of a particular antigen, can report their services accurately using codes 95144-95170. This type of treatment, referred to as "off the board," allows the physician to regulate and adjust the strength of the antigen at the encounter. If the physician who provides the "off the board" treatment also injects the patient with the allergenic extract, it is inappropriate to report an injection code (95115, 95117) in addition to the codes in the series 95144-95170.
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Code 95144 represents the preparation and provision of extract furnished in a single dose vial(s) by the allergist for administration by another physician. Single dose vials contain a single dose of antigen that is administered in one injection.

Codes 95145-95170 describe the preparation of the antigen, the antigen extract itself, and the physician's assessment and determination of the concentration and volume to use based on the patient's history and results of previous skin testing. These codes require that the number of doses be specified. It is immaterial whether the dose comes from a series of vials or from a single multiple-dose vial, because the code describes the dose, not the bottle from which it is drawn.

Again, per CPT guidelines, "office visit codes may be used in addition to allergen immunotherapy if other identifiable services are provided at that time" (CPT 2009, Professional Edition, American Medical Association, page 425).
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3.Preparation, Provision, and Administration:
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Codes 95120 through 95134 describe the entire service of preparing, providing, and administering (injection) the allergenic extract at a single patient encounter. Therefore, unlike model 2 above, the injection codes (95115, 95117) cannot be additionally reported to the codes range 95120-95134.

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