Procedure Code 86580 billed with 90471 or 90472

As a medical biller I find that my job allows for some interesting insight into how different medical offices bill their services and I always seem to stumble upon "gold" nuggets.

In this Medical Billing Example I am comparing two Pediatricians Medical Office in where the providers bill for a 86580 TB Intradermal Test:
1 Medical providers office includes a charge for 90471 Immunization Administrative code
1 Medical providers office bills for just the 86580 (no admin code attached)

Many coders would tell you (rightfully so) that a Doctor should not bill a 90471 for administrating the 86580 code. But are you curious to know what I found out on the office that includes a 90471? The medical office that bills for 90471 with use of 86580 in all situations received full payment for the 90471 .

The medical office performed this code over 50x's a year. When you take the high's on the allowables for insurance carriers:
90471 around $20-25
90472 $8-13

& we will say we billed 25 patients with a 90471 and 25 patients with 90472 we are close to increasing the providers revenue by $1000.00 each year.

This providers office is not contracted with Medicare (pediatricians) or Medi-Cal (california location). I did identify that all carriers including Blue Cross, Blue Shield, SCCIPA, Aetna, Cigna, UHC and Great West paid on the code.


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