Oncology & Hematology Coding Alert

Question: A patient reported to our office with wheezing, shortness of breath, and extensive rashes. Our physician did a scratch/prick test? How should we code this test?

Alabama Subscriber

Answer: You can report the scratch test (prick test) with CPT® code 95004 (Percutaneous tests [scratch, puncture, prick] with allergenic extracts, immediate type reaction, including test interpretation and report, specify number of tests). Your physician will perform the percutaneous (scratch, prick, or puncture) tests for inhalant allergies and for suspected food hypersensitivity. For the test, your physician will mark the areas on the patient’s skin with a pen (usually on the back or forearm) to identify each allergen or each allergens panel (A, B, or more) that will be tested. To be able to deliver the extract into the superficial layer of the skin, called the epidermis, your physician will use a disposable pricking device.

Check the number of units you submit: Bear in mind that each substance counts as a separate test. Be sure to code for each allergen administered by putting the number in the “units” field of your claim form.

For the practitioner ordering and rendering the test, remember to provide detail within the documentation to support the patient’s symptoms, exact number of allergens tested. Do not forget to include information regarding the observation time post testing, any outcomes of initial screening and the patient’s past, family and social history that may further support the medical necessity and performance of the tests.