Otolaryngology Coding Alert

Question: Can I bill an E/M service on the same day as an allergy test?

Virginia Subscriber

Answer: Limit claims for an E/M and allergy testing to services that are significant and separately identifiable from the testing. The Correct Coding Initiative version 14.0, effective Jan. 1, 2007, bundles 90 procedures (including most E/M codes) into allergy testing codes 95004-95075.

"The interesting thing is that in version 7.2, CCI said that codes with an -XXX- global fee actually do have a small global period," says Barbara J. Cobuzzi, MBA, CPC-OTO, CPC-H, CPC-P, CPC-I, CHCC, consulting editor of publications for the American Academy of Professional Coders in Salt Lake City. So you really shouldn't have been billing the E/M with allergy testing anyway unless the E/M was significant and separately identifiable and qualifies for modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service). The CPT 2008 allergy and clinical immunology introductory notes state that you can't bill an E/M for test interpretation and report, and "if a significant separately identifiable E/M service is performed, the appropriate E/M service code should be reported using modifier 25."

Example: You can use a modifier to break these edits if your ENT or nurse performs a significant and separately identifiable E/M service. If a new patient presents and the otolaryngologist performs and documents a history, exam and medical decision-making (MDM) and performs the allergy testing during the same session, you could report the appropriate E/M code (such as 99241-99245, Consultation for a new or established patient; or 99201-99215, Office or other outpatient visit depending on whether the patient was new or established) with modifier 25 appended, as well as the allergy testing code (such as 95004, Percutaneous tests [scratch, puncture, prick] with allergenic extracts, immediate type reaction, including test interpretation and report by a physician, specify number of tests).

Alternative: Suppose, however, that the ENT performs and documents a history, exam and MDM and schedules the testing for a later date. When the patient returns for testing, the nurse documents an interval history and does a brief exam to ensure that the patient is healthy enough for the allergy testing. In this case, you should not report a separate E/M code with the testing code(s), such as 95004 x 4, Cobuzzi says.

Lowdown: The edits bundle office visits (99201-99215), including nurse visits (99211) and consultations (99241-99245), into 95004-95075. CCI permits a modifier, such as 25, to override the edits.

-- Answers and/or information for You Be the Coder and Reader Questions provided by Barbara J. Cobuzzi, MBA, CPC-OTO, CPC-H, CPC-P, CPC-I, CHCC, consulting editor of publications for the American Academy of Professional Coders in Salt Lake City; Susan Garrison, PCS, FCS, CCS-P, CHC, CPC, CPC-H, CPAR, executive vice president of Magnus Confidential Inc. in Atlanta; David W. Kennedy, MD, FACS; and Cyndee Weston, executive director of the American Medical Billing Association in Sulphur, Okla.