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Allergy & Immunology

At PBA and Associates, we know how to help you with your sniffles. We have our own in-office expert in allergy medical billing and coding! Our specialist knows the payer codes and preferred drug list for every carrier. This list is updated every day.
If only coding for Allergies were as simple as learning the allergy codes and definitions found in the CPT book. However, it’s not as simple as just knowing the coding. Other aspects of allergy coding can create even more complications. So in order to understand the first coding concern, one needs to know a little about how reimbursement is determined for CPT codes.
We look at all components of allergy coding for reimbursement. This means what makes up the CPT code: The first is the physician work. The second would be the practice expense and lastly the malpractice expense.

You can trust PBA and Associates allergy medical billing experts to obtain your full reimbursement by our careful review of each payment or EOB.

Our allergy billing experts will code accurately, according to age, means of administration and any other relevant specificities. We are well-versed in all problem areas of immunology billing, including serum caps and the difference between build-up and maintenance dosages. Our medical billing specialist will assign exact codes for every treatment you render, from lung function testing to spirometry procedures and skin tests.

The most unpleasant aspect of patient care is obtaining insurance company approvals for immunoglobulin (IG) therapy. With that being said we would like to provide some tips for simplifying the process. We have these tips routinely result in gaining the required approvals.

Before You Start

Above all it is important to know the ground rules for IG therapy in PIDD both generally and in relation to the specific insurer. Particular payers often consider particular diagnosis codes to be supportive of the need for IG and other codes not. If you use the wrong code, there will be an immediate denial.

Most noteworthy is some payers are using preferred drug lists (PDLs) limiting the options with regard to brand. You must know the payer’s PDL as well. Usually, this information is available on the payer website or from the payer-provider rep, but sometimes the payer keeps it a secret, requiring the physician to make their best guess. Don’t guess, PBA and Associates has the information and the updates to assist your practice. We know the payer and the details.

Our Next Step :

Writing the Letter

As a result of your findings, you should start the letter by saying what you want. For example: “I am writing to request authorization for immunoglobulin supplementation therapy for the above-referenced patient with a disorder of antibody production. I have recommended intravenous immunoglobulin therapy for this patient.”

The IG Approval Letter:

Less is more

Less is more! Keep the IG approval letter to one side of a page and use the same description of the patient’s history, for example: “This patient had a long history of recurrent bacterial respiratory tract infections. An immunologic evaluation demonstrated a disorder of antibody production (laboratory studies attached).

The specific diagnosis is listed below. Because his infections could not be controlled with the most aggressive conventional therapy, this patient needs immunoglobulin supplementation therapy.”

List the ICD-10 code and its description, the specific product name with its J code followed by the dose in grams and the infusion mode and interval.

Example Letter:

Here’s an example with each of these elements printed in bold on a separate line.

D80.0 – X-Linked agammaglobulinemia, autosomal recessive agammaglobulinemia, hypogammaglobulinemia
Drug: Carimune J1566
Dose: 30 grams
Interval: every four weeks
Enclose copies of the diagnostic supporting lab studies with the letter.

This is the kind of expertise that gets you paid!

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    • As an Accountant, I am selective on who I refer to my clients. I have found expertise at every level with PBA and Associates. They are accurate, responsive and true experts in specialty practices, such as orthopedics, surgery centers/ facilities as well as cardiology and gynecology. We are always pleased with the medical billing and revenue streaming provided by PBA and Associates.
      Gary A.


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