Wiki Denied Claim Due to Wrong Code

[jeaner54175@yahoo.com]

Our facility just received a denied claim stating the primary diagnosis code was wrong. A patient came in for allergy injections that were ordered from another physician at an out of town allergy clinic. The code used was 95117 for an unspecified allergy (995.3) According to the CPT book the professional services are included if that is the only service provided. Does anyone have any thoughts on this.

Thank you,
Lisa

 

[mitchellde]

if the patient comes in for allergy injuections, the correct ICD-9 code is a V code for prophylactic reason, there is no current allergic reaction.

 

[Sandra Fender]

We offer the same thing in our office, we use 95115 for single and 95117 for multiple with 477.9. They bring there medication with them and the administration shot is included, we do not charge a 99211 with this visit