Otolaryngology Coding Alert

Question: When should you bill 95027 instead of 95024? I don’t have a complete understanding of the difference.

Wyoming Subscriber

Answer: Physicians use both 95024 (Intracutaneous [intradermal] tests with allergenic extracts, immediate type reaction, including test interpretation and report, specify number of tests) and 95027 (Intracutaneous [intradermal] tests, sequential and incremental, with allergenic extracts for airborne allergens, immediate type reaction, including test interpretation and report, specify number of tests) for skin testing for allergies. 

Your main clue to the correct code is whether the tests are sequential. Report 95024 according to the number of tests the physician performed using allergenic extracts, when the tests are not sequential.

For sequential tests or for those documented as intradermal dilutional testing (IDT), submit 95027.  

With 95027, the patient receives increasing amounts of the antigen until a reaction is seen by the person performing the test. With 95024, the patient receives one test per antigen with a fixed amount injected per test per antigen. The difference is that multiple dilutions, gradually increasing in strength are tested with 95027 while only one strength is tested with 95024. Some insurance companies require single dilutions to be tested before they will approve the increased testing with the multiple dilutions that you find with 95027. 

Example: Consider a patient who requires three tests of increasing strength to determine his end point for 14 allergens, including dog dander, pine, hickory, and Bermuda grass. You should report 95027 x 42 units (14 allergens multiplied by 3 tests). Each unit represents one stick or dilutional test per antigen.