Allergy visits

We run an allergy clinic at our practice. Serum is mixed once a month for all patients and placed in vials labled A B C etc. A pt comes in for their treatment and is given say 2 injections, one might contain serum from vials A & B and the other injection might have serum from C,D & F. Would we code it as a 95125? If vespids were done we would use the codes 95130 - 95134 depending on the # of Vespids? Any help would be appreciated.
Thanks

re: Allergy visits

Codes 95120-95134 describes complete service codes representing the combined preparation and supply of antigen for allergy immunotherapy in addition to the allergy injection provided. Medicare does not use these codes for payment purposes.
Example: https://www.bcbsri.com/BCBSRIWeb/pdf/medical_policies/AllergyImmunotherapyInjections.pdf
Different payers, varied rules.
http://medpolicy.ibx.com/policies/mpi.nsf/e94faffabc7b0da68525695e0068df65/5342e6028a8f36a78525793700687278!OpenDocument

re: Allergy visits

We are still a little confused to the correct way to bill for allergy services for our non-medicare patients. The allergy clinicians have been billing 95165 with the # units representing the number of anigens used with a 95117. They have been getting paid all along but we are wondering if this is indeed correct. So if a pt comes in and receives 2 injections with 4 different antigens should we be billing a 95125 and do you use units to indicate the # of antigens used or would it just be a 95125? Thanks

re: Allergy visits

Codes 95145-95170 represent the antigen itself, its preparation, and the physician’s determination of concentration and volume required for the planned schedule of injections based on skin testing and patient history. These codes are used to report the supply of antigen prospectively planned to be administered. (In some cases, the patient may not eventually receive the number of planned doses because of reactions or for other reasons. Regardless, it is appropriate to bill the prospectively planned supply of the antigen at the outset of the scheduled treatment.) The number of doses prepared and provided must be specified when reporting these codes. Administration of injections is not included in these codes.The interpretation of CPT® code 95165 has been controversial. The code is unlike others in that it includes the concept of a ‘dose,’ which is not defined in the CPT® manual. many private payers follow Medicare guidance: CPT® code 95165 is used to report multiple dose vials of non-venom antigens. Effective January 1, 2001, for CPT® code 95165, a dose is now defined as a one (1) cc aliquot from a single multidose vial. When billing CPT® code 95165, providers should report the number of units representing the number of 1 cc doses being prepared. A maximum of 10 doses per vial is allowed for Medicare billing, even if more than ten preparations are obtained from the vial. In cases where a multidose vial is diluted, Medicare should not be billed for diluted preparations in excess of the 10 doses per vial allowed under code 95165. Check with the payer.

re: Allergy visits

In Medical coding, the code 95165 explains about the preparation of antigens. These antigens can be single or multiple in range. Based on the antigens, either vial or ‘off the board’ is prepared. The code simply means the amount of antigen directed to patients during the treatment session. The so prepared vials consists of multiple doses.

re: Allergy visits

CPT® procedure code 95165 is used to report multiple dose vials of non-venom antigens. Effective January 1, 2001, for CPT® code 95165, a dose is now defined as a one- (1) cc aliquot from a single multidose vial. When billing code 95165, providers should report the number of units representing the number of 1 cc doses being prepared. A maximum of 10 doses per vial is allowed for Medicare billing, even if more than ten preparations are obtained from the vial. In cases where a multidose vial is diluted, Medicare should not be billed for diluted preparations in excess of the 10 doses per vial allowed under code 95165.
code 95165 Billing Samples
To bill a 10 cc multi-dose vial filled to 6 cc with antigen, submit CPT® code 95165 with 6 in the days/units field
If a physician removes ½ cc aliquots from a 10 cc multi-dose vial for a total of two doses, submit CPT® code 96165 with 10 in the days/unit field. (Billing for more than 10 doses represents an overpayment for the practice expense vial preparation.)
If a physician prepares two 10 cc multi-dose vials, submit CPT® code 95165 with 20 in the days/unit field. (The number of aliquots removed from the vials does not change the number of doses billed.)