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CPT code 95180 with 95144-95149

Loni Posted Mon 01st of June, 2020 12:51:58 PM
Please provide instruction on when to use CPT code 95180 (if at all) when billing for venom immunotherapy. If a patient receives 3 injections with honey bee venom over (3) intervals of 30 minutes each, what is the appropriate way to bill? AND would 95180 be included when billing for rapid desensitization for stinging insects ?
SuperCoder Answered Tue 02nd of June, 2020 05:18:50 AM

Thank you for your Question!

 

Use CPT® procedure code 95180 (rapid desensitization) when sensitivity to a drug has been established and treatment with the drug is essential. This procedure will also require frequent monitoring and skin testing. The number of hours involved in desensitization must be reported in the unit field. A visit to an allergist, which yields a diagnosis of specific allergy sensitivity but does not include immunotherapy, should be coded according to the level of care rendered.

CPT® code 95180 (Rapid desensitization procedure, each hour [e.g., insulin, penicillin, equine serum]) is reportable for rapid desensitization for each hour. You can bill this code as multiply the code by the number of hours the patient requires for desensitization. For example, if the process takes three hours, you should bill 95180 x 3. CPT® code 95180 is an hourly billing code (One hour=one unit)

 

Venom immunotherapy often begins with 3 injections of dilute antigen given each week for a number of weeks but is not cluster or rapid desensitization. It is billed as one unit of the venom code, depending on the number of stinging insects plus CPT® code 95117 (for the administration of two or more injections).

 

95144-95170 is used for the provision of the antigen mixing of the vials that are specific to each patient.

Code 95144 is for single-dose vials, where the physician empties a vial, injects the patient, and disposes of the bottle. This code is billed according to the number of vials prepared for the patient. 95144 (Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single-dose vial[s] [specify number of vials]). For example: at three units (95144 x 3).

 

At the subsequent visit, the physician uses the next bottle marked in sequence. Both 95144 and the subsequent codes, should be used in conjunction with 95115 and 95117.

 

Codes 95145-95170 are billed according to the number of doses, not the number of antigens in the doses. In other words, if the vial contains 20 different antigens and eight doses, the physician bills for eight doses.

The physician who created the antigen material puts the number of doses in the units column of the claim form when it is submitted.

Note: Allergy testing is not performed on the same day as allergy immunotherapy in standard medical practice. These codes should, therefore, not be reported together. Additionally, the testing becomes an integral part to rapid desensitization kits (CPT® code 95180) and would therefore not be reported separately.

Hope this Helps!

Loni Posted Thu 04th of June, 2020 12:37:56 PM
Thank you for your prompt response. Would you please clarify: is 95180 appropriate to bill with 95145-94149? For 90 minutes of honeybee venom immunotherapy, would it be correct to bill 95145, 95117 and 95180 for example?
SuperCoder Answered Fri 05th of June, 2020 05:07:56 AM

Thank you for your query!

Use CPT procedure codes 95115/95117 and the appropriate CPT procedure code from the range 95145-95170 when reporting both the injection and the antigen/antigen preparation service (complete service). These instructions also apply to allergists who provide both services through the use of treatment boards. Use CPT procedure code 95180 (rapid desensitization) when sensitivity to a drug has been established and treatment with the drug is essential. As there is no NCCI edit between these codes. Hence, you can bill these codes together.

 

Kindly check with your payer for any specific reimbursement guidelines.

 

Hope this Helps!

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