Confidentiality, Privacy and Security

95165 - CAN PATIENT TAKE HOME THE VIAL?

  • 1.  95165 - CAN PATIENT TAKE HOME THE VIAL?

    Posted 09-18-2019 13:24

    Hello -

    I have a question about 95165, multiple dose vials of non-venom antigens.  Our allergist charges this CPT for the initial series of shots, and then charges the admin after that.  However, he has had a patient recently ask for the vial to take with her to another practice.  The physician refused.  So here is my question, if a patient has been billed for, and presumably paid for 95165, does the provider have an obligation to send her with that vial?

    Any help is appreciated!

    Thank you, 

    Sarah



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    Sarah Jackson
    Compliance Manager
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  • 2.  RE: 95165 - CAN PATIENT TAKE HOME THE VIAL?

    Posted 09-19-2019 17:08

    Hi Sarah! This is a great question. I believe the vial now belongs to the patient and should be given to them.

     

    What is the doctor's rationale for refusing to give the vial to the patient?

     

    hen I worked in Family Practice, we had a patient who would bring the vial in for our office to administer.

     

    Warm Regards,

     

    Marilyn Freeman, RHIA, CHPS

    HIM/Compliance Officer

     

    Office: 916 930-3981 x362

     






  • 3.  RE: 95165 - CAN PATIENT TAKE HOME THE VIAL?

    Posted 09-20-2019 10:41
    Thank you for the reply.  The physician is not comfortable providing to the patient because of what he perceives to be risk to the patient.  If that is the case, then I'm thinking we must refund the 95165.  I did call the MAC on this one and they pointed me to the LCD that says administration in a medical facility is the only appropriate route of administration.  From that, I interpreted that we could send the vial to another physician, and/or refund if that patient chose to get the remainder of their care elsewhere.

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    Sarah Jackson
    Compliance Manager
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  • 4.  RE: 95165 - CAN PATIENT TAKE HOME THE VIAL?

    Posted 09-23-2019 09:12
    Hi Sarah,
    I don't have any legal knowledge, but I do know that when I was receiving allergy shots, my provider sent the vials to another provider so I could more easily get my shots administered during my work day. I feel like "provider to provider" is probably the safest way.
    Katie

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    Kathryn Wood, RHIA
    Assist Dir of Information Systems/Privacy Officer
    War Memorial Hospital
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