Dermatology Coding Alert

Question: A new patient came to our practice with a red, itchy rash on her arm. Our dermatologist made an initial diagnosis of nonspecified contact dermatitis. After thorough examination, the dermatologist applied patch tests the same day and asked the patient to return in 48, 72, and 96 hours for readings. How should we report this?

New York Subscriber

Answer: In this instance, you should report 95044 (Patch or application test[s] [specify number of tests]) because your dermatologist applied the patch tests.

You should also bill for the E/M services the dermatologist provides to the patient. You should determine the most appropriate E/M code (99201-99215) to report based on the scope of the examination, the key components the dermatologist covers with the patient and the level of medical decision-making during the visit.

Don't forget: You have to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code to notify the payer that your dermatologist performed an initial evaluation that led him to complete patch testing on this patient.

Exception: When the dermatologist administers multiple patch tests, he will usually apply the patchesto the patient's back for greater surface area. Once the dermatologist applies the patch tests, the patient cannot take a shower until after the dermatologist reads the final results.

But let's say the patient has a date that evening and asks to have the dermatologist administer the patch test on a different day because she has to take a shower before her date. So she arranges to come back in two days for the dermatologist to apply the patch tests.

When the patient returns to your practice, the nurse applies the patch tests. You shouldn't report an E/M service because the dermatologist did not provide any advice to the patient. You should report only 95044 for the patch test application.

For the follow-up visits to read the results of the patch test, report the appropriate E/M code. Often, once the test has narrowed down the offending allergens, the dermatologist will spend time with the patient discussing the diagnosis and counseling him on treatment options.

If the dermatologist spends more than half of the total length of the visit counseling the patient, you can use time to determine the level of E/M code to report.