Wiki Billing 95076 with E & M

[shavird@onyxsc.org]

We've been getting multiple denials from Aetna when billing and E & M with 95076 (Oral challenge). We have a 25 modifier on the E & M to distinguish as separate. We are an allergy practice that does follow-up visits with patients who are on allergy injections so it is often advantageous to schedule a f/u visit with an Oral Challenge for the convenience of the patient. Any suggestions would be most welcome. Thank you.

 

[LeeJager]

First, I would suggest appeals as it sounds like you're coding correctly. I would also consider the DX codes that are being submitted. You don't mention which of the two (OC or E/M) is being denied, but if the challenge does not have the appropriate DX codes (eg Z01.82, followed by the allergy being tested for) or has unrelated codes that are more applicable to the E/M than the challenge, you could run into issues there. But first and foremost, appeal!