Allergy shots

[Barry Page]

If a patient brings in their own meds for an allergen shot(s), 95115 (single) or 95117 (2 or more) would it be appropriate to add an office visit with a -25 modifier if this was the sole purpose of the visit? Now to add to this there are two dx code V07.1 Desensitization to allergens and V07.2 Prophylactic Immunotherapy which does not make sense to me at all. Does the reading of vitals justify the office visit with the -25 modifier and does the fact that the medication was prescribed by another provider (outside the practice) have any bearing on the coding here? Is the provider forced in this situation to perform some form of evaluation and management therefore warranting the Office visit? I am confused by this because I have a clear answer form what I am being told by my study but people out there are saying in the real world the situation is entirely different and things wont be coded the way I expect. My opinion of this advice is that it is bad advice and is from somebody who has become sloppy in their coding.

 

[Alicia Scott]

In my opinion if that is the reason for the visit then you can not use -25.
-25
The E/M service must be significant and separately identifiable, beyond the usual pre and post-procedure work performed by the same physician on the same day as a procedure of other service.
-Documentation must include the evaluation and decision making components of an E/M service: history, exam and MDM.
-The documentation for both the problem-oriented E/M and the procedure or other service must stand alone as billable.
-A different dx is not required for the use of -25; however, documentation must support the use of -25.

 

[Barry Page]

Thank you Alicia for your reply, this is exactly what I think but it is hard when you come up against somebody who has years of coding experience and this is what they use as their backup. It would be nice to learn ways of putting forward our arguments for the ways in which things should be coded when we come up against challenges such as this.