Allergy question on CPT 95165

[lataashwini23@gmail.com]

I dont have lot of knowledge on Allergy coding , If patient comes in for their allergy injection do we need to bill dilution (CPT 95165) each time patient comes in for injection ?

 

[Sefstratis]

Depends upon insurance type, some allow a bulk bill of antigen mixed, and when patient comes for the shot you would only bill for 95115 or 95117. If not bulk billing antigen, you would bill a unit value per antigen dose or per ml depending upon your insurance guidelines, some dont pay for diluent and if you have a 10ml vial you get to bill 10 doses regardless of whether administering .5 ml or not. If your vial contains two antigens your 95165 would be 2 units and the shot code 95117.

 

[Dridgway]

Depends upon insurance type, some allow a bulk bill of antigen mixed, and when patient comes for the shot you would only bill for 95115 or 95117. If not bulk billing antigen, you would bill a unit value per antigen dose or per ml depending upon your insurance guidelines, some dont pay for diluent and if you have a 10ml vial you get to bill 10 doses regardless of whether administering .5 ml or not. If your vial contains two antigens your 95165 would be 2 units and the shot code 95117.

I have been billing 95115 and 95117 together with 1 unit and I always get one paid and one denied.
Recently the have both been denying due to the diagnosis code. I checked with Encoder Pro and there is only one dx that is approved and that is the exact code I am billing yet it is still denying. Any ideas on what I could do to get these paid?

 

[Rbbeatty]

You cannot bill 95115 and 95117 together. There is a CCI edit against these codes. Both of these codes are billed with 1 unit. Use 95115 if you are giving 1 injection, and 95117 if you are giving two injections.

 

[Joyr]

New to allergy-Medicare was billed 95165 and it was denied because apparently the patient is an inpatient during the time that we billed and Medicare is denying CPT 95165 inappropriate POS and denied due to inpatient status. Do we need a modifier to get Medicare to cover this charge?