We bill a standard #32 of the 95004 prick tests because this is the # of allergens + the control that is on our testing board. Patient starts out with the prick test on the skin, then depending on reaction the RN proceeds forward to the intradermal challenge test (95024)
Most of the time the two #'s don't match due to not doing a challenge intradermal for something that didn't have a prick test reaction. It is a strictly patient to patient determination.
Take a look at the practice parameter's listed here. (as referenced in MLN Matters see below)
http://jcaai.org/page/Practice_Parameters/index.v3page;jsessionid=hki6k2kh6t4l
under the paramaters for allergy diagnostic testing:
D. Number of Skin Tests
• The evaluation of inhalant allergy may require up to 70 prick-puncture tests followed by up to 40 intracutaneous tests, which are
ordinarily performed when prick/puncture tests are negative. Under special circumstances and in certain geographic areas, a
greater number of prick/puncture and/or intracutaneous tests may be appropriate. However, in many parts of the country and
probably in most cases, fewer tests are required.
• The number of prick/puncture tests performed for suspected food hypersensitivity may vary from less than 20 to as many as 80
tests, depending on the clinical situation.
This CLEARLY indicates it is not an Every patient situation- but case to case basis. There is no reason to assembly line test all patients when they will all have such different responses and reactions.
as for 95165- Medicare has very specific rules that apply for vial billing. Consider a "dose" 1cc. This is even if you are giving your patients a titrating dose of the allergen which is standard practice. You can only mix a vial for the patient based on the # of 1cc doses. So if you mix one vial with 5cc, you can only bill a until # of 5. See supporting link below
https://www.noridianmedicare.com/cg...J&tmpl=part_b_viewnews&style=part_ab_viewnews
due to MLN Matters (
http://www.cms.gov/MLNMattersArticles/downloads/SE0812.pdf)
Medicare states: "While these policies may vary between contractors, CMS strongly encourages physicians who provide allergen immunotherapy to closely follow practice parameters agreed upon and endorsed by the professional societies that represent allergy, asthma, and immunology practitioners (like the Joint Council of Allergy, Asthma, and Immunology (JCAAI)), as long as those parameters fall within the coverage criteria of applicable LCDs.
•
Specific practice parameters are provided on the JCAAI website at
http://www.jcaai.org/ and are important for all practitioners and providers to study and understand."
From what we have found Allergy billing is a fairly new and ever changing beast. Get to know and understand the guidelines and paramaters for JCAAI. Find out who your physician is accredited through and what their paramaters are, ( our MD is through AAOA) and set your own office policy and procedures into place.
Good luck!