Otolaryngology Coding Alert

Question: How should I bill preparation of three separate 10-dose immunotherapy vials (using different antigens) to commercial carriers? Should I use:

1. a single line (as I do for Medicare): 95165 x 30

2. three separate lines as: 95165 x 10, 95165-59 x 10, 95165- 59 x 10.

Wisconsin Subscriber

Answer: You should bill using the #1 scenario you indicate above for 95165 (Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single or multiple antigens [specify number of doses]). Follow this method for consistency's sake unless you receive written instructions to bill another way. However, if when you are processing payments you identify a payer that consistently pays only for 10 units when you bill for 30 units, you should call them and find out why they are processing the claims incorrectly. You should appeal the incorrectly paid claims and try to get their rules in writing. Your last step is to bill the vials as you indicate above the second way, with three lines, using the 59 modifier. That is the action of last resort.