danaguy71@yahoo.com
Networker
I have a FL Medicaid provider who's specialty is Allergy & Immunology. He is performing allergy injections (CPT code 95117). As an example, one of his patients has been getting the injections for a couple of years according to medical records and claims history reviewed. The patient is coming in 1-3 times per month (usually twice a month) and the provider bills 95117, 1 unit for each injection. What I don't understand is that, when it is time for the preparation of the immunotherapy (CPT code 95165) they bill 95165, 25 units and bill the code again, 99165-76 (repeat service) for another 25 units. So, they are being paid twice for this.
I'm not questioning that the services are not needed, documentation indicates they are. I just don't understand why every time they bill for the prep, they bill twice, once with modifier 76 for repeat service. The documentation indicates that the patients HAVE to come into the office to get the injections so they can be monitored for reactions and such. I understand that it can take up to 3 years of repeated injections for therapy to be effective.
The patient in question was diagnosed with allergic rhinoconjuctivitis and had multiple positive skin test reactions to food. Therefore the provider recommended and started the immunotherapy. The records they sent for the DOS for the preparation do not address the billing issue I am concerned with (99165, 99165-76). The FL Medicaid policy doesn't appear to address this issue either. It just speaks to "medical necessity". Could this billing be so they have enough to cover the monthly injections assuming that the patients will come in for their scheduled therapy? Does this sound like a normal billing practice? If not, what do you suggest?
thank you!
I'm not questioning that the services are not needed, documentation indicates they are. I just don't understand why every time they bill for the prep, they bill twice, once with modifier 76 for repeat service. The documentation indicates that the patients HAVE to come into the office to get the injections so they can be monitored for reactions and such. I understand that it can take up to 3 years of repeated injections for therapy to be effective.
The patient in question was diagnosed with allergic rhinoconjuctivitis and had multiple positive skin test reactions to food. Therefore the provider recommended and started the immunotherapy. The records they sent for the DOS for the preparation do not address the billing issue I am concerned with (99165, 99165-76). The FL Medicaid policy doesn't appear to address this issue either. It just speaks to "medical necessity". Could this billing be so they have enough to cover the monthly injections assuming that the patients will come in for their scheduled therapy? Does this sound like a normal billing practice? If not, what do you suggest?
thank you!