Allergen Immunotherapy. Subcutaneous

Transcription

1 Allergen Immunotherapy 1. In order for an A/I to receive RVU credit for supervision of AIT, I understand that the note must be co-signed by the A/I provider who is physically present in the office to supervise AIT. Must the provider co-sign all portions of the patient note? Or co-sign the entirety of the note with a statement that the encounter/ait has been reviewed? Subcutaneous 1. There should be some indication that the AIT is reviewed and supervised by the physician on site. There is not a specific guideline stating each encounter must be signed. 2. Yes, as long as there is direct supervision. 2. If the A/I does not sign the note, but is listed as a "supervising provider" does this yield the same RVU credit as the A/I physically signing the note? 2. A. In short, what should the A/I provider do to obtain maximum RVU credit for the provider for an AIT visit? 2. A. The RVU value is only for the expense and malpractice. There isn't any physician work RVU value in the injection codes. 3. By CMS guidelines, there isn't any work RVU included in the routine immunization code, only the code which includes physician counseling of the patient. 3. What should the A/I do to obtain maximum RVU credit for stand-alone immunization encounters? (For example, a patient coming in for a flu shot separate from a scheduled visit for follow-up or AIT.) Per AAAAI: "The code does not include the provision of antigens used in rapid desensitization, but does include the injections during the period of time desensitization is occurring." Anytime involved in the desensitization of the patient with direct patient care is counted under the CPT code Can you clarify if the monitoring post the build-up is billable time? There seems to be quite of bit of confusion as to what construes a true billed unit, any advice is appreciated. I have been reading through the common Q&A s on your website. I have a few questions about IT mixing. If our internal pharmacy is preparing the vials of allergens and sends to the clinic to be administered, should we be billing for the supply of the allergens? If we are not able to bill 95165, how are we to cover the cost of the allergens that are mixed? We also use an outside company Greer for these as well, again how do we cover the cost of paying the outside company if we are truly not preparing the vials in clinic (95165)? When a patient begins immunotherapy, our physicians enter the formulary into the Rosch Immunotherapy System. The Rosch System records the initial immunotherapy program, the injections given and the subsequent orders for more extract. The doctors have been signing the orders for the extract. This is time consuming and our physicians would like to streamline the process if possible and so I have the following questions: To my knowledge, the only way you can be compensated for the doses if you aren't mixing in the clinic is to use the codes which are for the injections and the doses in the same code (95120 and 95125). Medicare however does not recognize these codes as payable. Other payers pay however. 1. Payers are now requiring when the patient is re-evaluated or new vials are manufactured, the formulary be signed by the physician. Payers are looking to make sure there is supervision and necessity for all of the doses. 2. This is more of a billing issue than a medical necessity issue. As long as the orders are signed

2 Allergen Immunotherapy 1. Since the physicians write the formulary which is prescribed for a 3-5-year period, will one signature on the formulary suffice for all the orders written for the entire 3-5-year program (providing the formulary doesn t change)? 2. One of our insurance carriers reimburses for only 30 doses per day. Therefore, those patients on 2 or more vials of extract need to have their vials made on separate days in order to receive reimbursement from the carrier. In this case, the physician signed the order for the full number of vials. However, our nurses split the order into two or more separate orders so that the vials can be made on separate days to accommodate the 30 doses per day carrier requirement. Is it necessary for our physicians to sign these split orders even though they previously signed the single order? 3. Can the physicians give permission to an RN to sign the split extract orders mentioned above? Can you please explain the difference between and 95120, and provide a sample situation of when may be used? Subcutaneous for the total number of doses anticipated to be given to the patient, you should be okay. 3. Nurses can only work incident to the physician. Again, splitting your orders for different day billing is okay but not a medical necessity issue. CPT code and are combination codes which include the provision of the allergy extract as well as the injection of the allergens. The is only for the provision of allergen extract. Can an ENT provider bill for allergy injections? This way our patients that are in the middle of injections will not lose their allergy desensitization, as well as the practice does not lose any potential revenue from billing for this service. An insurer (Tufts) has questioned a billing code we have been using. We are a facility based practice at a medical center, and order Immunotherapy serum from Greer. We charge 95120, which is described as professional services for allergen immunotherapy in prescribing physician s office or institution, including provision of allergenic extract, Because we obtain and purchase our treatment sets from Greer, the insurer is saying this is not an appropriate code because we do not prepare the treatment sets in our office. If you have an ENT physician in your practice, they may be the billing provider for allergy injections. You may have a different billing physician from the ordering physician. You are correct by using the The CPT Code reads Professional services for allergen immunotherapy in the office or institution of the prescribing physician or other qualified health care professional, including provision of allergenic extract, single injection. The code does not include the supervision and preparation of allergen extract. The CPT code for those services is What is the appropriate code to reimburse us for the cost of the treatment set when it is obtained from an outside manufacturer? My question is, we have an Allergy RN who is going to be retiring in December and I am looking to fill her position with a LPN. Is this ok or is there a protocol to follow that an RN needs to be doing the mixing of serums. I know the doctor has to be on site for the mixings, just not sure if it An LPN by coding guidelines may mix allergy serum. You should, however, check your state guidelines for LPN and what they are allowed to perform under New York State guidelines.

3 Allergen Immunotherapy can be done with just having LPN s doing the mixing or not. Subcutaneous Can AAAAI provide a generic guideline on best practice for billing allergy serum to commercial insurances? I understand Medicare is per cc. 1. We have always understood that an MD must be on premises for office staff to administer IT. What is the current policy? Is a PA or an LPN also qualified to be the supervising person? Which physician extenders could be on premises in lieu of an MD, as long as standing orders are present? 2. Are there any extenders besides a PA who could supervise shots? And do you happen to know if the compensation from private insurers is the same for PAs and MDs for the same service? If a patient has anaphylaxis after receiving an allergy shot, an office visit of is used for the complexity of the situation. It is documented the time spent in observation and using epinephrine. Does the note need to have the wording > 50% of the visit was spent face to face in counselling? This seems inappropriate as this is not counselling but intervention. For most commercial insurances you should bill per the CPT guidelines. Many commercial insurances, however, have limits on the number of doses allowed per day or per year. 1. "An LPN is not considered a supervising provider. A PA may supervise injections if the PA is credentialed with the payer for the patient. You would be billing under the PA provider number." 2. "You must be a billing provider to be the supervising provider. To my knowledge for allergy injections, only PA, NP, and physicians are billing providers. Private insurances are paying either by Medicare guidelines at 85% of the allowed amount or the same amount as physicians. It varies by payer. You would need to check with your payer." You may support your level of service for an E/M by either the complexity of the visit or by counseling and coordination of care. You would not use both. If the history or the exam plus the medical decision making supports a 99215, you would not need a statement indicating time spent in counseling and coordination of care. Allergen Immunotherapy Can we bill insurance for the pure antigen that is used in sublingual allergy drops? Sublingual The FDA has not approved sublingual allergy drops. You would need to bill the patient or bill insurance with an unlisted code. Allergen Immunotherapy For CPT 95180, we understand that rapid desensitization is charged per hour of the desensitization procedure. Our question concerns what specifically the desensitization test Other Immunotherapy Services As long as the patient is receiving medical attention and is not waiting in the waiting room, you should include the time in the total time for the desensitization. You would need to continue to

4 Allergen Immunotherapy includes. A patient may, for example, receive a schedule of injections over the course of two hours at 30 minute intervals; we then require the patient to remain under observation for 2 hours after the final injection to monitor for reactions. During this time, the patient is occupying an exam room and is being checked on by the medical staff every 30 minutes to monitor vitals/signs of reaction. This observation time follows the guidelines of the 2011 Joint Task Force on Practice Parameters, co-published by AAAAI, which state Systemic reactions with rush schedules have been reported to occur up to 2 hours after the final injection. For that reason, subjects receiving rush immunotherapy should remain under a physician s supervision for a longer waiting period than the usual 30 minutes recommended for conventional schedules (e.g., hours after allergen immunotherapy extract administration during rush immunotherapy) (ps28 Cox et al, J Allergy Clin Immunol January 2011, Allergen immunotherapy: A practice parameter third update. ) Other Immunotherapy Services document the evaluations of the patient at each time interval to support your time components charged. You should also have a discharged time documented. Is it correct to include the time spent in observation after the final injection as part of the units? One of my colleagues did an in office administration of a vaccine as follows: I did a scratch test with TdaP.(with controls) Then I gave 0.05cc TdAP IM The 20 min later 0.10cc Then 20 min later.15cc Then 20 min later 0.20 cc Total time and face to face = 2 hrs 10 min. I am assuming the injections were given IM or subcutaneously? If so, you can use the therapeutic/and or diagnostic injection code Alternatively, if you are intending to desensitize the patient, you could possibly use the for rapid desensitization and not bill for the injections just the time. Total time in the office was 2hr 10 min but I doubt it was face to face Allergy Testing and Challenge We recently did medication testing on a gentleman who experienced problems of diffuse erythema and a drop in blood pressure with concern of anaphylaxis requiring treatment with epinephrine, corticosteroids, and antihistamines. There were 10 different medications of concern administered at the time. We had the gentleman in our office for testing to these different medications with a total of 48 for code Medicare denied stating over MUE Drug Hypersensitivity You could appeal with documentation to see if the MAC would override the edit. My other thought is did you bill on different lines with a 59 modifier to indicate different medication testing on the same day?"

5 Allergy Testing and Challenge Drug Hypersensitivity limits. Patient was in the office for 3-1/2 hours total for this testing session. Will Medicare override an MUE with further documentation or do you have any other suggestions for this claim for us. I have a question about ASA challenge and ASA desensitization: how to bill. If the doctor wants If the intent is to desensitize the patient to ASA, billing the entire time for desensitization to challenge aspirin first and then do a desensitization due to results of challenge, can this be would be appropriate. billed on same day? Say an oral challenge takes 6 hours, then continues on to a desensitization for 2 more hours and then patient returns next day to continue desensitization. Can I bill oral challenge for the 6 hours and then a desensitization for the 2 hours same day? Our clinic has a few questions about charging an office visit when the patient is in the clinic for skin testing and/or oral challenge. I did find the attached coding for penicillin challenge and I just wanted to verify this information still holds true? Since oral challenge is time based codes, it would be inappropriate to bill for E/M visit unless the challenge is discontinued due to a reaction then the E/M can be billed? It s my understanding the time for the completed portion of the challenge would be billed along with the appropriate level of E/M, however the challenge time does NOT count towards the E/M time? I also found the information below in the AAAAI media library. Skin testing: CPT if an E/M service is charged on the same day as the test, the E/M service must be significant and separately identifiable beyond the definition of the testing code. The information you have found still is correct and the responses to your questions regarding the E/M and challenge are also correct. Patch testing: CPT when the patient returns for the reading and removal of the patch we could then bill an established patient E/M code. What is the proper procedure: We give amoxicillin oral at 0.03, 0.06, use time documentation and so on is this considered an oral challenge or a rapid de-sensitization? Patient had skin testing done to evaluate allergy to amoxicillin which was positive. Amoxicillin was required to add to her treatment regimen to treat a chronic bone infection. The doctor did an oral desensitization to amoxicillin. I had a question regarding Pre pen and Pen G testing. Do I bill for the Pen G and Prepen separately from code 95018? I have looked at the ALK site and also found the article from AAAAI Coding for Penicillin Testing, did not see a drug code. Our provider has been approached by a local hospital to do inpatient PCN testing. The patients would not be established patients with our practice but rather patients who are hospitalized for What is your intent? Are you finding out if the patient is allergic or do you know they are allergic to penicillin and you are desensitizing? If the intent was to desensitize the patient with the multiple doses, you may use the If the intent was to determine if the patient would have a reaction after ingesting the multiple doses, you would bill an oral challenge. The cost of the penicillin is included in the RVIU value for the For inpatient testing, your physician would have a consultation (either a or a ) for the evaluation of the patient prior to ordering the penicillin testing. If your

6 Allergy Testing and Challenge non-allergic reasons that have indicated that they have a Hx or think they have a Hx of PCN allergy. The hospital wants us to determine if the patient truly is allergic to PCN so that they may treat the patient with that classification of antibiotics. I believe that when done in the office we can only bill for the penicillin testing (no E&M code). Since these patients are inpatient, would the doctor also have to do an H&P on a different date than the test? Drug Hypersensitivity physician administers the test and is with the patient the entire time, he could charge for the and the If he writes orders and the nursing staff administers the test, your physician would not be able to charge for the testing. I have found your spreadsheet with coding information. I am aware now how to bill CPT instead of CPT and CPT I still would like to know if we should be billing for the penicillin serum and pre-pens? We are trying to bill for a lidocaine challenge performed using subcutaneous injection. The test was done using IV and spanned a total of 3 hours. This was performed in similar fashion to ingestion challenge testing, CPT codes Do you have any billing suggestions other than to use unlisted CPT code 95199? The CPT codes for penicillin are for drugs and biologics which includes both percutaneous and intradermal testing codes. If your physician administers multiple doses of penicillin over a period of greater than 60 minutes, you may also charge for the in addition to the skin testing codes. The cost of the penicillin is included in the testing codes. You may use the codes for the injection and the IV code 96365, etc. for the lidocaine challenge. The codes in this section are not only for therapeutic services but also for diagnostic and prophylactic services. Allergy Testing and Challenge I have a question regarding the ingestion challenge test, CPT I am having trouble finding any current information, I have been reviewing your "New Codes for Ingestion Challenge Benefit Allergy Practice. Old Codes Terminated. New Codes Effective January 1, 2013." My question is when interventional therapies are performed, and the testing is over the 61 minute threshold: Do you bill for both the testing (95076) and the appropriate E/M code? The documentation states "If a patient has a reaction requiring intervention therapy (i. e., injection of epinephrine or steroid) the challenge is over. Any continuing symptoms consistent with a positive challenge test should be reported using appropriate E/M coding. There is no clear directive if the testing is billable with the E/M code. In order to bill an E/M you need to meet the elements, if we count the pretest information for the test portion of the billing, providers would need to have a separate history for the E/M. Food According to CPT guidelines, if an E/M is required, the testing time ends. Also according to CPT guidelines, you would need to be able to support the definition of the 25 modifier which indicates a "separate and identifiable" service is provided "on and beyond" the testing or challenge. The CPT code includes the history and exam required to perform the challenge. Any other services "on and beyond" these guidelines could be charged with an E/M if the documentation supports the services. The documentation for both an E/M and the ingestion challenge would require two separate notes - one for the testing and one for the E/M. I hope this information is useful.

7 Allergy Testing and Challenge We are advising NOT to bill for the testing but would like your input and any other current directives for the Ingestion challenge, CPT If a parent brings in a child for peanut allergy testing and has avoided peanut because their sibling has a peanut allergy what ICD 10 code to we use for the skin testing if we need to rule out peanut allergy? Food There really isn't a good code for this scenario even though it does frequently come up in the allergist's office. There is a screen code for immune disorders Z13.0, or not otherwise specified Z You would need to follow it with the family history code for allergies Z I would also advise the parent, it may not be covered by the insurance depending on their policy. Sorry I don't have a better answer. Allergy Testing and Challenge How would we bill for prick testing for latex. They did 3 pricks 1 histamine, 1 saline and one saline soaked with a latex glove? 95018? They also had the patient wear a latex glove for 30 min? Could this be billed with 95044? We have been using the code with a avg. of 100 sticks, but insurance companies are paying for only 30 sticks. Any ideal why and how we can get paid? Do we need to use another code? Should we be using instead of 95028? General The prick test would be appropriate for the If there is an interpretation and documentation of the glove contact with the skin, you could charge one unit of the Your payer is following CMS guidelines for the number of tests allowed per day for the You may want to check and make sure you are performing delayed testing and not the or which have higher limits. Otherwise, you would need to appeal each and every testing with notes to override the edit. Can we bill for Elgiloy? It is a specialty metals-strip product that we have to pay for. If so, what codes? If you are performing intradermal testing with readings a short time later on the same day versus delayed you should be using the If you are using the metal to patch test the patient, the cost is included in the value of the CPT code You can t perform the test without the materials. Allergy Testing and Challenge Inhalant

8 Allergy Testing and Challenge We are having trouble getting reimbursement for CPT and still CPT 95012, would you be aware if this is a problem for most Allergists as well? Is appealing the best way to go for 96160? We were told that we should send the recent guidelines with an appeal for and should get payment, however this has not worked with one repeal already. Inhalant The CPT is not covered by all payers. Some of the payers feel it is still experimental. You can have the patient sign an ABN and then charge the patient if you wish for those payers who are not covering it. As for the CPT 96160, it is bundled in the NCCI edits with your allergy testing codes; but I didn't find it bundled with any E/M. You might try using the 59 modifier and a different diagnosis for the from your E/M if it is being included into your E/M. I did not find it bundled however. Allergy Testing and Challenge Stinging Insect, Other Insect Asthma We have been instructed by our hospital coders to never bill for allergic rhinitis for any patient who is being coded for any type of asthma. Is this correct? Treatment of AR is separate from the treatment of asthma and does increase time spent and medical decision making, so we aren't sure what to do. Diagnosis If you are treating the patient for their allergic rhinitis, you should use the diagnosis code specific to the type of allergic rhinitis along with the type of asthma diagnosis. You are correct, they are treated separately. There are unspecified codes which bundle together." Asthma Evaluation and Management

9 Asthma When a patient comes in for an allergy injection and has not done their peak flow monitor test prior, we have our portable meter that we use (purchase mouth pieces), I found a code S8096, can we bill this to the insurance or do you have a suggestion as to what we can do to help in our cost? Also, our asthma patients, we have an Asthma Control Test that we give to patients to answer questions to help us monitor their symptoms, is there a code we could use for this or is it part of E&M code? Evaluation and Management You can bill the S code but S codes are usually only for third party payers - not government payers. You may need to use the generic supply code for the government payers. The ACT can be charged with the CPT I was hoping to get some information on procedure code (aerosol bronchodilation). All of a sudden most Insurances are not covering this procedure. They are bundling them with the Office visit, even with a modifier. I have tried 59 and 76. Do you have any suggestions on how to get these to process? I have a question regarding Exercise Challenge CPT code. We had been using the now deleted for the challenge. There are codes (Exercise test for bronchospasm- this includes pre and post spirometry, pulse oximetry as before but now mentions ECG recordings) and (Pulmonary stress testing 6 min walk, does not mention pre/post spirometries). We have not done ECG recordings for this before for Exercise challenges. Do you have a recommendation as to which is best to replace for challenge, I would think except for the ECGs, and code is closer to code 94620, then adding codes for spirometries? I m a little confused about the use of CPT for Asthma Control Test. When I try to use it, I get a coding error - Add-on procedure code has been submitted without an appropriate primary procedure code. We only do ACT s for our asthma patients and use an asthma Dx and I attached that Dx to the Is there an additional code that should be/required to be used with it? According to the NCCI edits 2017, it is not bundled with an E/M. You should appeal. You will need a separate chart document for the CPT from the E/M. NCCI edits do only allow one CPT per encounter with the patient. Even though the 2018 CPT book is out you should still use the until January of The code which describes the exercise challenge is the If you don't perform all of the components of the codes, you may use a 52 modifier on the code for reduced services to indicate a reduction in the components performed. You would be correct in using the asthma diagnosis code for the You may want to check the payer's website for approved diagnoses with the CPT Asthma Our practice has a number of patients on Xolair, and for new starts, while we await prior authorization, we have given doses that were drug rep samples, or doses that were provided by Treatment Biologics: e.g. Xolair, Cinqair, Nucala The CPT or the CPT is for the administration of Xolair. You are okay using these codes with the medication provided.

10 Asthma Treatment Biologics: e.g. Xolair, Cinqair, Nucala the Xolair starter program. We have wondered if there is any issue billing for administering the Xolair (e.g or 96372) for these sample or starter program doses? First, we have a patient who doesn t feel comfortable self-injecting her Dupixent so we are having our nursing staff inject it for her. The question I have is, should that be a nurse visit billing or a biologic injection 96372? Since we re not drawing up the drug or reconstituting it like we do with Xolair and Nucala, I felt may be more appropriate, but I wanted to see if you had any input. You should use the for the therapeutic injection. If the patient has other issues, you could use the nurse code instead of the just the injection code. Also, with Fasenra they are suggesting billing the for the injection. This is again a prefilled syringe, so I wasn t sure on that as well. I just found out that there is a way of coding Xolair wastage. Our office has a few patients that get 375mg and waste 15mg but we ve never coded it. Is this something that is required? You may bill for the wastage you purchase. You add a JW modifier to the HCPCS code J2357. You would not bill for any Xolair which you have not purchased. Most of our patient s Xolair is supplied by their specialty pharmacy and we have some patients that never show up to receive their injections and we are stuck holding the vials. Could this code be used for this? Asthma Treatment - Education Asthma Treatment Nebulizer, Medication Codes Dermatology

11 Diagnostics, e.g. punch biopsy, patch testing Evaluation and Management My provider saw a new patient in the office for a severe allergic reaction (cause undetermined), allergies, asthma and then an ingestion challenge. He took a detailed history and physical exam. In this instance the doctor spent a lot of time with this person as a new patient appointment and then went ahead with the ingestion challenge. If we have the documentation to support this would it be appropriate to bill E/M code and for this visit? Association with Other Services As long as the encounter was for more than enabling the ingestion challenge, you may bill for the E/M as well as the challenge. Evaluation and Management 1- For a visit, E and M coding requires "3Dx/Tx". Does this mean that there have to be 3 separate diagnoses with 3 separate treatment plans? Or, can there be a Dx such as allergic rhinitis to dust mite with 3 separate treatments such as medications, immunotherapy and environmental control? 2- Does PFT add complexity to E and M visit? I understand that a patient who comes in for follow-up for 2 chronic conditions, e.g. Allergic Rhinitis and Allergic Conjunctivitis is considered "Moderate Risk". Normally there would be 2 treatment plans, one for each of the chronic conditions. It would be coded as I was thinking of how we might still code this as 99214? 1.) What if they had an acute problem, such as a URI, cough or skin infection during their visit for follow-up of their 2 chronic conditions? 2.) What if one of the 2 conditions was not in good control and needed a new prescription or treatment? 3.) What if I discovered that the patient had hypertension and needed a referral to their internist or to a cardiologist. Either a new diagnosis or that their known hypertension was not under good control? 4.) What if there are multiple treatment plans for the 2 conditions such as immunotherapy, medications, environmental control? Decision-Making: Complexity and Visit Level For a 99214, you need three different treatment plans for three established diagnoses doing well. A PFT does not add to the complexity of the E/M since you are reimbursed for the procedure. For your scenarios 1 through 3, it could raise your level of decision making to moderate complexity (99214). Your scenario number 4 would not change the level from low (99213) to moderate as long as both chronic conditions are doing well.

12 Evaluation and Management Would any of these raise the visit code from to 99214? Decision-Making: Complexity and Visit Level ICD-10 Diagnosis Codes We have been recently receiving denials on our G8420 CPT Code with our pediatric patients. We use the Z68.52 mostly. UHC is just now denying saying age not appropriate G8420 is an adult code. Haven t found anything online with new updates pertaining to these codes. Are providers able to charge the patient for A codes? I thought I remembered from a past training that we are NOT supposed to but at a recent meeting, I heard some doctors are. There are some insurances that are processing the charges and it shows as patient responsibility or having it go towards their deductible. There are also some that don't allow A codes. Are we allowed to charge the patient if it goes to deductible per their insurance? For Medicare, can the following ICD-10 code be used as a primary code for E&M and also primary ICD code for prick skin testing (CPT 95004): Other adverse food reactions, not elsewhere classified, subsequent encounter - T78.1XXD (Primary) We had a patient referred to us for possible tree nut allergy. The patient had eaten the tree nut before without incident. My provider documented that the patient went to ED and received various medications and released in improved condition. He also documented the patient s symptoms as scratchy throat, redness of the eyes and 4 to 5 hours later patient had lip swelling & generalized urticaria, but no respiratory compromise or other symptoms. There isn't an age specific G code for BMI documentation. I am not sure why UHC would deny other than they may not require reporting of the BMI. You may charge the A codes. If it is a non-covered service, you should let the patient know in advance it will be their responsibility. If it is allowed but goes toward their deductible, you may also charge the patient. You may use the same diagnosis code for an E/M and the allergy testing code. It is easier to pass the payer edits, however, if you use a different diagnosis code for the E/M than the testing. It is not required however. You are correct. It would not be anaphylaxis but rather the adverse food reaction. Code first the signs and symptoms and then the T code for the adverse food reaction. My question is wouldn t this be Adverse Food Reaction T78.1XXA and code the symptoms Urticaria & Lip Swelling NOT Anaphylactic Reaction, since he stated no respiratory compromise or other symptoms? What ICD 10 and CPT code for flu vaccine for MEDICARE patients I should use, and what code for flu vaccine supply? What ICD 10 code do you use for a large local reaction to an allergy injection? Is it different for a delayed reaction? In our office, we give allergy injections and I was informed that I needed to start coding Z51.6 (encounter for desensitization to allergens) as a primary diagnoses and then the ongoing diagnoses (i.e. J30.1, J30.81, J30.89). Would this be correct? I m a little concerned about doing "The ICD-10 code for Flu vaccine is Z23. You will use the G0008 for the administration and then the appropriate CPT code for the type of flu vaccine you are using. (90674, 90756?)" You would code for the erythema or the localized swelling for a large local reaction. (R22.3_ for localize swelling or L53.9 for erythema NOS). You may use the Z51.6 as a secondary code to indicate the patient is presenting for desensitization. I have not seen payers requesting it as a primary diagnosis.

13 ICD-10 Diagnosis Codes this especially with Medicare patients. Does Z51.6 even need to be coded? If so, could you explain why? Immunodeficiency In what context are codes and used? Diagnosis Code The and would be if lab procedures were performed for IgE levels. Immunodeficiency Treatment Subcutaneous and Intravenous Gammaglobulin Mid-Level Services Other We are having some issues with payer insurance groups verifying locum tenens to see if they can see the insurance groups members if they are not on the contract with the organization. Essentially, one payer says they do not accept locum tenens to see their specific patient group as they are not credentialed with said group. Aside from not scheduling with that specific insurance group during locum tenens tenure with our organization, is there a way we can still bill for the locum tenens for that payer insurance group? When you bill for locum tenums, you should be billing under the physician who they are replacing with a Q6 modifier attached to indicate a locum tenum. Unless the insurance company has a policy stating the physician needs to be credentialed, it should not impact your practice. If the payer does require credentialing, you would need to not schedule with the payer for any locum tenum work performed if the physician is not credentialed.

14 Our doctor saw a patient for a consult in the ICU last week. I was hoping to get some guidance as it is not something that our doctor normally does. 1. The patient he saw was by request of another Doctor. He saw him Wednesday in the ICU for a consult at 8:30pm (after hours). 2. The following day (Thanksgiving Holiday) he saw the patient again in the ICU for aspirin desensitization which was from 8:30 am to 2:30 pm and involved direct face to face with the patient. You would bill for the initial encounter with either the hospital consult codes or the admit codes. You would use the consult codes if the payer still recognizes them as payable codes. If it doesn't, you would bill the appropriate level of admit code ( ). For the second day for the aspirin desensitization, you would bill the for rapid desensitization. It is a per hour code. You could bill x6 for the total number of hours for the desensitization. You would not have a subsequent hospital visit. How should these two visits be coded? 1. I was thinking or Would the fact that it was after hours change the code? 2. I was thinking along with x 1 and x 3 (360 minutes total). Or should it be billed time based for face to face time?