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Pediatric Coding Alert

Reader Questions:

Don't Assume All Codes Include Related Supplies

Published on Sat Jan 22, 2005

Question: In the January 2005 Pediatric Coding Alert, the reader question "Nebulizer, Vaccine Codes Include Inherent Supply Costs" states that you shouldn't bill for supplies in addition to the immunization administration and nebulizer codes. Does this mean I should never report supplies?

Illinois Subscriber Answer: No. Even though the immunization administration codes and the nebulizer codes include the supplies, you may be able to separately bill other supplies.
 
Most pediatricians don't have access to the AMA resource based relative value scale (RBRVS) review update committee database that lists which supplies each code includes. And not all payers follow the RBRVS, which assigns practice expense value reimbursements for the costs associated with performing a service or procedure.
 
Until this information is made public, you may separately bill for supplies. That being said, if a payer is reimbursing based on RBRVS policy and associated practice expense data, payers may deny the charges as inclusive in the procedure.
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