When a patient gets multiple immunizations, we bill a multiple of the fee for immunization administration. If the kid gets 3 shots, we bill 3 times the fee for giving each shot (eg 90460). If 90460 is $1, then the fee for 3 shots would be $3.
In 6.5.6:
--CMS 1500 is correct
--Invoice does the correct arithmetic ($3 in the example above), but LEAVES OUT THE MULTIPLIER. It just says: 90460...$3.
Problem is this: I send the invoice to my billing service. They bill insurer. Biller enters the amount (correct) but there is no multiplier. The insurer's computer assumes that only 1 unit of 90460 was given, so no matter what I bill for, they pay me only what they pay for 1. This is a big issue with a lot of money involved. In the example above, the insurer may pay $1 for 90460. They will pay me $1. They won't pay $3 if they don't know I gave 3 shots.
My only fix is to print the invoices on paper, recall how many of each CPT, and write it in by hand. Yes, this is a problem.
Wolffe Nadoolman MD
