Pediatric Coding Alert

Diagnosis coding may not be as simple as you think

If you aren't getting paid for 95115-CPT 95117 , your diagnosis coding could be to blame.
 
When billing allergy immunotherapy services, "we have problems with some plans paying," says Teresa Carrillo, coder at Children's Medical Center in Tucson, Ariz. The claim form's diagnosis code may be the reason, coding experts say.
 
"We haven't encountered many problems with reimbursement of codes 95115-95117," says Shelley Bellm, CPC, who works for Colorado Mountain Medical, a multispecialty office that includes family medicine, internal medicine, pediatrics, ob-gyn and gastroenterology. Key: You have to use an allergenic extract diagnosis, not a prophylactic immunotherapy diagnosis.
 
Practices that use V07.2 (Prophylactic immunotherapy) for the diagnosis code may face denials, Bellm says. "Patients receive allergen immunotherapy injections because of a known allergy." So you should often use diagnosis codes 477.0-477.8 (Allergenic rhinitis ...).
 
Check with your major insurers for other accepted ICD-9 codes. Some plans may follow Medicare's lead and accept additional diagnoses, such as:

• 372.14 -- Other chronic allergic conjunctivitis

• 493.90-493.91 -- Asthma, unspecified

• 518.3 -- Pulmonary eosinophilia

• 995.0 -- Other anaphylactic shock

• 995.3 -- Allergy, unspecified

• V15.0x -- Personal history of allergy, other than to medicinal agents.  Note: Examples are from Empire Medicare Services (New York, Connecticut, Delaware, Massachusetts)