Wiki Allergy shots billed with office visit?

[greatbiller]

Hello everyone:

I have a question regarding allergy shot billing. I was reviewing our personal EOBs earlier today, and every time my husband goes to his allergist for an allergy shot (every 2-3 weeks), they are billing for an E&M code and respiratory function study in addition to the allergy shot. This seems excessive, and if you consider that there is a $20 copay every visit, thanks to the E&M code being billed, it adds up over the course of a year.

I asked him if he sees a nurse practitioner, PA or doctor when he goes in to the office for his regular allergy shot, and he said no. He sees the MA and that is it.

Can anyone provide any insight? I am going to call our insurance carrier and find out what specific CPT codes are being billed and then contact the doctor's office staff to discuss the situation if necessary.

Thank you in advance, and everyone have a wonderful week!

Patricia Murrin, CPC-A, RCC

 

[mitchellde]

they should not be billing an office visit for a scheduled injection, and never if he is seen only by the MA. Also if he only gets the injection there should not be a respiratory function study. I would question the doctors office and if you are not refunded the copays , then notify your carrier.

 

[greatbiller]

Thank you! I code radiology exclusively, so evaluation and management codes are not my area of expertise by any stretch of the imagination. I will be contacting their billing office today!

(I am seeing a nice dinner out in my future if all of those copays are refunded...)

 

[lmartien]

I agree completely with Debra. If a patient comes to the office for the allergy shot only, even if seen by a nurse or doctor, and nothing other than the allergy shot is provided, it would be inappropriate to bill an E&M service. And unless a PFT is done with a written or recorded report that's out as well.

I billed for allergy and asthma specialists for several years and this was our policy.

Linda Martien, CPC, CPC-H, CPMA