# Allergen coding 86003



## stacycallean (May 15, 2017)

Does anyone have any knowledge in coding an Allergen panel? We are having to bill 86003 at 36 units, but should we be using modifier 91? If so, do we have to code it out on 36 lines or can we show everything on 1 line?


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## CodingKing (May 15, 2017)

Single line 36 units. There is no MUE on the code but its possible payer may have an edit. I found one plan that limited to 30 per year.


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## stacycallean (May 15, 2017)

With or without modifier 91?


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## CodingKing (May 15, 2017)

No modifier needed. That would be more for codes that don't say "per or each" in the description or repeat of the same allergen. I had this one provider who kept adding 76 repeat procedure on "each 15 min" codes its like, no doc you didn't do the same test twice it just took 30 min instead of 15.


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## emunoz (May 25, 2017)

stacycallean said:


> Does anyone have any knowledge in coding an Allergen panel? We are having to bill 86003 at 36 units, but should we be using modifier 91? If so, do we have to code it out on 36 lines or can we show everything on 1 line?



Do you know if this code is covered by Medicare? 

Thanks!


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## CodingKing (May 25, 2017)

Depends, Check to see what the LCD says for your MAC.

For example L33261 - First Coast Service Options, Inc):




> B. *In vitro testing* (blood serum analysis): immediate hypersensitivity testing by measurement of allergen-specific serum IgE (CPT code 86003). Special clinical situations in which specific IgE immunoassays may be appropriate include the following:
> ·        Patients with severe dermatographism, ichthyosis or generalized eczema.
> ·        Patients who cannot be safely withdrawn from medications that interfere with skin testing (such as long-acting antihistamines, tricyclic antidepressants).
> ·        Uncooperative patients with mental or physical impairments.
> ...




Or

*L34313 - Noridian Healthcare Solutions, LLC*



> Quantitative or semi-quantitative in vitro allergen specific IgE testing (CPT code 86003) is covered under conditions where skin testing is not possible or is not reliable. In vitro testing is covered as a SUBSTITUTE for skin testing; it is usually not necessary in addition to skin testing. The number of tests done, frequency of retesting and other coverage issues, are the same as for skin testing. The indications for using in vitro testing instead of in vivo methods must be documented with the claim.
> 
> Examples of indications for in vitro testing include the following:
> 
> ...


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## emunoz (May 26, 2017)

Thank you for this information! I'm looking for Medicare Part B is Texas. 

I checked on Novitas Fee schedule and $0.00 was listed. Would that mean that it isn't a covered code?


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## tpadmasree@gmail.com (Feb 26, 2018)

We are getting denials for qty we bill even though we bill as one claim item for RAST panel, 86003(X26, X30, X42 etc) for different payors. Medicare paid for 86003 X 26 without any problem. Of course we are not using any kind of modifiers like 59 or 91 So my questions are
1: we got denial 86003 X 42,for quantity issue, can we just change the quantity to 26 and rebill or is there any preferred procedure ?
2: Where can I find the allowable quantity details for different payors like Medicare, Gateway, Highmark, Amerihealth etc
Padma


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