Allergy Test Documentation Is Key to Obtaining Correct Payment

Correctly coding and obtaining payment for allergy tests can be complicated. Most carriers cover the majority of allergy skin tests, but other common tests, such as skin end point titration, have been considered noncovered services by many carriers until recently. Tests that are considered experimental are noncovered, but depending on the carrier, these tests may be reimbursed under specific circumstances that must be documented in the physician's notes.
 
Another factor that complicates billing for allergy tests is the large number of tests that may be performed, as well as the variability of allergies, symptoms and sensitivities among patients. According to the introduction in the Allergy and Clinical Immunology section in the CPT 2001, "The number of tests performed should be judicious and dependent upon the history, findings and clinical judgment. All patients should not necessarily receive the same tests or the same number of sensitivity tests." As a result, the physician's documentation must indicate clearly not only the medical reason for the test but also the type and number performed.
 
CPT includes at least 17 different codes that describe nearly as many allergy tests, of which five are most commonly performed:
 

95004 -- percutaneous tests (scratch, puncture, prick) with allergenic extracts, immediate type reaction, specify number of tests;
 

95010 -- percutaneous tests (scratch, puncture, prick) sequential and incremental, with drugs, biologicals or venoms, immediate type reaction, specify number of tests;
 

95015 -- intracutaneous (intradermal) tests, sequential and incremental, with drugs, biologicals, or venoms, immediate type reaction, specify number of tests;
 

95024 -- intracutaneous (intradermal) tests with allergenic extracts, immediate type reaction, specify number of tests; and
 

95027 -- skin end point titration.
 
Code 95004 describes the basic skin allergy test, such as a Multitest or a prick test, says George Smaistrla, CHFP, clinical administrator with Associated Otolaryngologists of Decatur SC, a five-physician practice in Decatur, Ill. Multitests are typically performed in blocks of eight. Some physicians may perform as many as 64 tests at one time. Others perform far fewer tests (32 or less), because they do not include food products or because they perform other percutaneous tests.
 
Code 95024 describes intradermal injections of one or more substances. Intradermal injections are performed to test for one or more of the following items:
 

"control" substances, such as histamines, glycerines and saline;
 

substances that did not appear to have a reaction to  the percutaneous test; and
 

food or other substances not subject to the percutaneous test.
 
Protocols among practices providing allergy tests may vary considerably, and protocols within each group may also differ from one another. But most offices use 95004 and/or 95024. According to Aetna Coverage Policy Bulletin No. 38, "Prick or puncture tests [...]

- Published on 2001-09-01