Otolaryngology Coding Alert

Question: When a patient undergoes patch testing and then returns for a follow-up visit where the ENT checks and discusses the results, do I report 95044 for both visits? Can you explain patch testing and how to bill for these encounters?

AAPC Forum Participant

Answer: You will report the appropriate number of units of 95044 (Patch or application test(s) (specify number of tests)) for the first visit — do not report additional units of the code for follow-up visits.

The patch test does not produce immediate results like percutaneous testing. Unlike percutaneous tests, your provider will only apply the patches containing allergen samples to the patient’s back on the first visit and will read the test results during a follow-up visit. This entails removing the patches, examining the skin, and documenting the number of tests and the patient’s allergic reaction to one or multiple substances (in the patch) in a report at a subsequent visit. So, the patient is asked to return in 48 hours (and, in some cases, once more after 72 and/or 96 hours) so that the physician can see the reaction to the allergens.

Initial visit billing: You will report the number of units of 95044 depending on the number of allergens your physician is testing for using the patch test. Note, the testing code includes the time spent talking with the patient about the risks and benefits of treatment and/or waiting for the test results.

Subsequent visit billing: When your ENT sees the patient for a follow-up visit to check the patch test results, you cannot report this encounter with additional units of 95044. Reading the results at a subsequent visit is included in the initial billing of 95044 and not separately reportable.

In many cases, your physician can pinpoint the allergen causing the allergic reaction in the patient based on the results of the tests, and they might spend time with the patient discussing the diagnosis and counseling them on treatment options. When billing these subsequent visits, assuming all criteria are met, you may then be able to bill for an evaluation and management (E/M) service from 99212-99215 (Office or other outpatient visit for the evaluation and management of an established patient …) using medical decision making (MDM) or time to determine the level of E/M code to report.