Allergy Coding Alert
Reader Question: Same-Day Injection and Office Visit
Question: We have a patient who has asthma and allergic rhinitis. How can my doctor receive full payment for both the allergy injection and the office encounter on the same day? Our carrier always wants to pay only for the injection, and maintains the office encounter is included in the injection.
Iowa Subscriber
Iowa Subscriber
Answer: The physician is evaluating the patient because of the asthma and not the allergic rhinitis, which makes the service significant and separately identifiable. To ensure that the carrier knows the injection is not included in the E/M service (or vice versa), the allergist must:
In this situation, the physician sees the patient for asthma. The appropriate asthma code (493.xx) should be linked to the E/M service, whereas the injection procedure (for example, 95115) should be associated with the allergic rhinitis diagnosis (477.x).
Simply listing the diagnoses in section 21 of the CMS 1500 claim form is not enough. To associate an ICD-9 code with the corresponding CPT procedure code, the listing number in section 21 for a particular diagnosis must be entered in section 24E of the form in the same row as the CPT code.
In this case, the allergist would list the following two diagnoses in section 21: 477.x and 493.xx.
The CPT code for the injection would be listed in the first row of section 24D and "1" submitted in the first row of section 24E. The appropriate established patient visit code (9921x) would be entered into the second row of section 24D (with modifier -25 appended), followed by a "2" in
section 24E.
If the carrier still does not pay for both services, the denial should be appealed. Some private carriers do not pay for E/M services and allergy injections provided at the same time, regardless of CPT and Medicare coding regulations.
Note: Some allergists do not charge for E/M services performed at the same time as allergy injections because the patient may have to pay for part of the E/M out of his or her own pocket. Many insurance policies pay for injections at 100 percent but have a copayment (usually $15) for visits.
Reader Questions were answered by Susan Callaway, CPC, CCS-P, a coding and reimbursement specialist and educator in North Augusta, S.C.; Barbara Cobuzzi, MBA, CPC, CPC-H, a coding and reimbursement specialist and president of Cash Flow Solutions, a medical billing firm in Lakewood, N.J.; Teresa Thompson, CPC, an allergy coding and reimbursement specialist in Sequim, Wa.; Chrissy Rogan, CPC, a coder in the practice of Metropolitan ENT, in Alexandria, Va.; and Lori Wyvill, CPC, office manager in the allergy practice of Suzanne Weakley, MD,
- Published on 2001-12-01
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