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Allergy Question 95615

K

katerina_98

Networker
Messages
43
Location
Phoenix, AZ
Hello

I am new to allergy billing and we order our allergens mixed from another company to our clinic. They want me to bill 95165, any suggestions?
 
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katerina_98 said:
Hello

I am new to allergy billing and we order our allergens mixed from another company to our clinic. They want me to bill 95165, any suggestions?
Click to expand...
Hi Katerina:

I suggest querying the physician, if he confirms the 95165 with the allergens being mixed outside the practice, then advising them what the correct code is: If you are Administering only, 95115 or 95117. or for Administration and provision of the allergen 95120 - 95134...
 
Hi Katerina ~

I'm having the same issue with a PCP in our network and I'm new to allergy coding. He's billing for the 95165, but is ordering them from an outside vendor. I'm wondering if they should be using the supply code, 99070, with a description in 17a and send it with an invoice? However, there are guidlines with some payors that will only pay up to a certain number (50 or 75 per year), so they need to track. The other thought I had was to append a modifier to 95165 so they could track and we could show they were not actually mixing it. Maybe a -52?

95120-95134 - is the injection plus the mixing of the allergen, so this set of codes wouldnt work for our situation.

I'd love to hear any suggestions.

Thanks
Kelly
 
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