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ALLERGY VIAL TESTING

SuperCoder Posted Thu 27th of October, 2011 15:10:18 PM

I bill for an ENT that wants to bill out a CPT 95024 with CPT 95165-saying that the 95024 is used to test the vial. I am trying to clarify for the Dr that this testing code is for allergies-not the testing of the vial, and that testing the vial is included in the 95165 code. Am I correct and is there a laymans explanation that I can give to them.
Thank you,
Maureen

SuperCoder Answered Thu 27th of October, 2011 20:47:08 PM

It is not clear from your question, what is the reason for performing the procedure. Based on that status certain procedures are performed and coded accordingly.

Given below are the scenarios and when to bill what. Please check which scenario matches your case.
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If the Reason of Visit is to know the Cause of Allergies, then the physician determines which allergens the test should include based on the patient’s history, likely exposure in his or her geographic area, and type and length of symptoms.
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The office should code each individual scratch test the physician or nurse performs, broken down by allergen type. You should report 95004 (Percutaneous tests [scratch, puncture, prick] with allergenic extracts, immediate type reaction, specify number of tests) for allergens such as pollen, mold, mildew, grasses, trees, and dust mites, or 95010 (Percutaneous tests [scratch, puncture, prick], sequential and incremental, with drugs, biologicals, or venoms, immediate type reaction, specify number of tests) for allergens such as penicillin, horse serum (used in vaccines) or insect venoms (bee and wasp stings), and enter the number of scratch tests in the units box.
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If the patient Shows a Strong Reaction to a Scratch that is a Combination of Allergens and the physician wants to Test the Components individually, you may report those additional tests in the session as well.
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Also, if a suspected allergen shows up negative on a scratch test, the physician can choose to perform intracutaneous or intradermal tests, the injection of an allergen directly into the skin. CPT provides four codes for intradermal testing that divide the codes by type of allergen, amount of allergen, and reaction speed:

95015 - Intracutaneous (intradermal) tests, sequential and incremental, with drugs, biologicals, or venoms, immediate type reaction, specify number of tests

95024 - Intracutaneous (intradermal) tests with allergenic extracts, immediate type reaction, specify number of tests

95027 - Intracutaneous (intradermal) tests, sequential and incremental, with allergenic extracts for airborne allergens, immediate type reaction, specify number of tests

95028 - Intracutaneous (intradermal) tests with allergenic extracts, delayed type reaction, including reading, specify number of tests
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Once the physician knows the causes of a patient’s allergies, you can order the extract. You really need to watch your units when coding, and here’s why: For Medicare, a billable dose is defined as 1 cc, while many injections are often far less than that (usually only .5 cc).

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Policy Example: New York’s Empire Medicare local coverage determination (LCD) states the following: “When billing 95165, providers should report the number of units representing the number of 1cc doses being prepared. A maximum of 10 doses per vial is allowed for Medicare billing, even if more than 10 doses are obtained from the vial. Medicare should not be billed an additional amount of these diluted doses under code 95165.”
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Example: Your physician orders a 5 cc vial from which the nurse will administer 10 doses. You code: 95165 (Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single or multiple antigens [specify number of doses]) x 5 units. This is the correct coding because you must code based on the number of ccs in the vial, not on the number of clinical doses the patient will receive.

SuperCoder Posted Fri 28th of October, 2011 12:30:44 PM

The patient was already tested for the allergy,the vial was already prepared and the provider wants to test a very small amount to determine if the patient can have a shot. The provider already knows what the patient is allergic to,has made the vial and is now trying to determine if the patient can have the shot. The provider is testing the extracts not the allergens.

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