Billing inconclusive allergy testing

Carol.Dohmen

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An allergy test was performed on a Medicare patient but came back "inconclusive", therefore a blood work allergen panel was ordered. We billed an allergy test as 95004x54 to Medicare which was paid. The patient is now complaining that she is going to call Medicare and state the testing was not done.

We cannot locate any information on this issue. The testing was done but the result were inconclusive.
Can anyone reference any policies on billing inconclusive testing or 95004 in particular?
 

CodingKing

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As long as you perform a procedure you can bill it. The results do not determine whether you can bill services performed or not.
 
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Carol.Dohmen

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Thank you for the information.
We were just informed that the allergens were tainted on the provider's end making a false positive.

If the incorrect results were the provider's fault does that change anything?
Should it still be payable?
 

mitchellde

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If the procedure was performed incorrectly cause a false result, then it should not be billed. I read a little ditty in the federal registry when I was researching the use of the 91 modifier for labs that stated the provider could not charge for a repeated study if it was repeated due to provider error or due to equipment failure. So I would believe that logic would be employed here that the patient needed additional testing due to provider error and therefore the original study should be void.
 
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