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Allergy and Clinical Immunology

  1. #1
    Default Allergy and Clinical Immunology
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    One of our providers bill for services 99203 E/M with -25, 94375 and CPT code 95004. The claims partially pays denying code 95004 as inclusive. ICD-9 codes billed are:477.0 and 493.90.

    I read the Medicare guidelines for billing this code and it stated the following:
    "Providers have expressed confusion related to the reporting of units for allergy testing services described by CPT codes 95004 through 95078. Nine of these CPT codes instruct providers to specify the number of tests or use the singular word “test” in their descriptors, while five of these CPT codes do not contain such an instruction or do not contain “tests” or “testing” in their descriptors. The lack of clarity related to the reporting of units has resulted in erroneous reporting of charges for multiple allergy tests under one unit (that is, “per visit”) for the CPT codes that instruct providers to
    specify the number of tests. Effective January 1, 2006, CMS is differentiating single allergy tests (“per test”) from multiple allergy tests"

    Unit billed (10) not sure if this affected the reimbursement...

    Please advise.....Thanks

  2. #2
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    Greeley, Colorado
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    Who is the insurance?
    Lisa Bledsoe, CPC, CPMA

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