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Allergy CPT code quantity questions

Heidi Posted Mon 10th of September, 2018 11:10:55 AM
I have a few codes that allergy is using that we are wanting to confirm how quantities are entered, can you help us on this matter? CPT code 95018- 9 tests were done, so we used quantity 9, is that correct? CPT code J7510- 60 Mg were done, so we used quantity 60, is that correct? CPT code J1200- if more than 50 Mg are done, can we bill multiple quantities to equal up to the amount?
SuperCoder Answered Tue 11th of September, 2018 02:51:51 AM

Hi Sherry,

 

CPT code 95018 states Allergy testing, any combination of percutaneous (scratch, puncture, prick) and intracutaneous (intradermal), sequential and incremental, with drugs or biologicals, immediate type reaction, including test interpretation and report, specify number of tests. If provider has specified 9 tests then as per MUE 9 units would be appropriate to bill for CPT code 95018.

 

HCPCS Code J7510 states Prednisolone oral, per 5 mg. If total 60 mg was administered then the 12 units of J7510 would be billable.e.g 60/5=12

HCPCS Code J1200 states Injection, diphenhydramine HCl, up to 50 mg. If more than 50 mg was administered then 2 units of J1200 would be billable. Append modifier JW (Drug amount discarded/not administered to any patient) to the second line of  J1200 claim form e.g.

J1200X2

J1200-JW

 

Hope this helps!

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