Otolaryngology Coding Alert

Question: Our ENT completed allergy testing for a patient in the outpatient clinic, which is located in the hospital’s emergency department. The physician is employed by the hospital and his clinic is also hospital-owned. Can he bill for the allergy testing?

Oregon Subscriber

Answer: Whether your physician can bill for the testing depends on the situation.

Outpatient facility allergy services are covered under APCs (ambulatory payment classifications). If this is a hospital-based outpatient clinic, then you can report the service. An employee of the hospital (including the physician, if that’s the case) can administer the test and the hospital can bill it under the APC.

If you’re coding for a physician practice owned by the hospital, however, the test may or may not be billable. The physician can administer and bill for the service, but his nurse cannot administer the test and bill it as incident-to the physician for services provided in a hospital outpatient facility.