Otolaryngology Coding Alert

Question: Our provider wants to bill a separate E/M when going over the results and treatment options following allergy testing. Are we allowed to bill for a separate E/M in addition to the test?

Louisiana Subscriber

Answer: Let’s assume your provider performs a 95004 (Percutaneous tests (scratch, puncture, prick) with allergenic extracts, immediate type reaction, including test interpretation and report, specify number of tests) in addition to the follow-up evaluation and management (E/M) visit to go over the results and develop a subsequent treatment plan.

A National Correct Coding Initiative (NCCI, or CCI) edits check reveals a modifier “1” status between your new or existing patient E/M code and 95004. Typically, when dealing with in-office procedures, you’re not supposed to separately report an E/M code when the E/M service relates to the procedure. However, allergy testing is a little different. As you can see in the 95004 code description, the allergy testing includes interpretation and report. So, if the provider performs allergy testing and meets with the patient to go over the results, then you should consider the E/M portion of the visit to be included in 95004.

However, if the provider takes time to devise a treatment plan with the patient based on the results of the allergy test, you may report a separate E/M code with modifier 25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service) attached. The treatment plan should include a thorough discussion of all the patient’s therapeutic options — and otherwise — based on the results of the testing.