Question: If a nurse has to check vitals to make sure an allergy injection is the correct quantity or if she has to educate the patient about the administration or side effects of the injections, we’ve been billing 99211 with 95115 or 95117. There is only 1 diagnosis for both CPT codes. We are getting denials for the injection. Can we attach modifier 25 to 99211 or should we consider 99211 included in the injection?
Answer: You may report 99211 and 95115/95117. There is no National Correct Coding Initiative edit on the codes.
You, however, should not use 99211 every time you are giving an allergy injection. Providers may bill for a nurse-only 99211 when dealing with clinical issues surrounding allergy injection administration, according to a Joint Council of Allergy, Asthma and Immunology (JCAAI) member letter.
The nurse must document the medically necessary E/M service that she provided. The JCAAI suggests the service could represent directing a nurse who gives injections on what to do if a patient was ill; missed an injection; or had a large, local reaction or mild unreported systemic symptoms after his last injection.
Be careful: Do not consider the required post-injection observation sufficient reason for reporting 99211. Codes 95115-95199 include the professional services necessary for allergen immunotherapy, according to CPTs Allergen Immunotherapy instructions. CPT goes on to state, Office visit codes may be used in addition to allergen immunotherapy if other identifiable services are provided at that time.
You do not technically need modifier 25 on 99211 with 95115 for single injection or 95117 for multiple injections. When you bill 99211 for providing clinical advice related to the injection, modifier 25 is unnecessary and does not apply, according to the JCAAI.