Clinical Context
A 35-year-old patient with a documented systemic allergic reaction to a hymenopteran sting presents to an allergy clinic for venom immunotherapy. The clinician reviews the patients history, verifies prior sting reactions and specific IgE or skin test results identifying sensitivity to a single insect venom (for example, yellow jacket). After informed consent, baseline vital signs are obtained and emergency resuscitation equipment is made available. The provider prepares and administers a measured dose of the appropriate stinging insect venom extract in the office, observes the patient for an appropriate monitoring period for systemic or local adverse reactions, and documents dose, lot number, site, and post-administration status. The typical workflow includes pre-injection assessment, verification of the correct venom for a single insect type, administration of the dose by the provider, post-dose observation, and documentation including any management of adverse events. Typical site of service is an outpatient allergy clinic or physician office. Service type is in-office therapeutic injection/allergen immunotherapy for a single insect venom.
Coding Specifications
| Modifier | Description | When to Use |
|---|
25 | Significant, separately identifiable evaluation and management (E/M) service by the same physician on the same day | Use when an E/M visit is performed on the same day as the immunotherapy and is separately documented and significant beyond the procedure |
| 26 | Professional component | Use when reporting only the professional component of a service that has a technical component (rare for this injection but applicable if applicable billing separates components)
| 52 | Reduced services | Use when the immunotherapy session is partially reduced or discontinued after initiation for clinical reasons
| 53 | Discontinued procedure | Use when the injection attempt is started but terminated due to patient reaction or other immediate clinical issue
| 59 | Distinct procedural service | Use when another distinct service or procedure is performed on the same day at a different anatomic site or distinct service unrelated to the immunotherapy
| 76 | Repeat procedure by same physician (note: not in provided list) | Data not available in the input.
| 78 | Return to operating/procedure room for a related procedure during the postoperative period | Rarely applicable; use only if patient returns to procedural area for management of complications of the injection (provided in input list)
| 80 | Assistant surgeon | Use when an assistant surgeon participates (uncommon for office immunotherapy) (provided in input list)
| QX | Qualified non-physician practitioner | Use when a certified registered nurse practitioner or physician assistant furnished part of service in accordance with payer rules
| QY | Attending provider of service under a teaching physician when resident performed the service | Use when teaching physician oversight rules apply
| Taxonomy Code | Specialty | Notes |
|---|
| 207K00000X | Allergy & Immunology | Specialists who most commonly prescribe and administer venom immunotherapy |
| 208000000X | Family Medicine | Family physicians who provide venom immunotherapy in office settings
| 207R00000X | Internal Medicine | Internists who manage allergy immunotherapy
| 208D00000X | Pediatrics | Pediatricians who administer venom immunotherapy to children
| 363A00000X | Nurse Practitioner | NPs who may administer or assist in therapy under supervision
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|
T63.441A | Toxic effect of venom of wasp, accidental (unintentional), initial encounter | Represents a documented systemic reaction to a wasp sting prompting venom immunotherapy consideration |
| T63.442A | Toxic effect of venom of hornet, accidental (unintentional), initial encounter | Represents hornet venom exposure with clinical reaction relevant to immunotherapy selection
| T63.443A | Toxic effect of venom of bee, accidental (unintentional), initial encounter | Bee sting causing systemic allergic reaction leading to consideration of venom immunotherapy
| T78.2XXA | Anaphylactic shock, unspecified, initial encounter | Used when a patient has experienced anaphylaxis from an insect sting, supporting need for venom immunotherapy
| Z88.0 | Allergy status to penicillin (example) | Data not available in the input.
| Z91.048 | Allergy to other specified drugs, medicaments and biological substances | Data not available in the input.
| Z77.22 | Contact with and (suspected) exposure to environmental tobacco smoke | Data not available in the input.
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|
95115 | Professional services for venom immunotherapy not otherwise specified; single injection | Used for single-venom immunotherapy injections when reporting physician or professional services for the dose administration; relates as alternate coding depending on payer rules |
| 95117 | Professional services for venom immunotherapy; two or more injections | Used when multiple venom injections are administered at the same visit; contrasts with single-insect single-injection reporting
| 36000 | Introduction of needle or intracatheter, vein | May be used if intravenous access is obtained for emergency care during management of a severe reaction; ancillary to office administration
| 93000 | Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report | Performed if clinical status during reaction warrants cardiac monitoring during or after a systemic allergic reaction
| J0091 | Injection, epinephrine, per 0.3 mg | Medication code for epinephrine that may be administered during emergency treatment of an anaphylactic reaction following venom injection