Primary Care Coding Alert

Question:  Our physician’s documentation regarding an allergy test is as follows:

“We went ahead with the lidocaine test dosing protocol starting with prick testing and moving her way up to 0.1mL subq of 1-10 and 0.1 mL subq of full strength, then 0.5 mL subq, then 1.5 mL subq, lidocaine 1%, lot #6003407, expiration date 7/13.”

How should we report the testing?

Connecticut Subscriber

Answer: For allergy testing, you should generally report a code from the 95004-95071 series in CPT^®. The exact code will depend on the method of the test (e.g. percutaneous, intradermal, etc.) and other factors.

Your physician’s documentation (“starting with prick testing”) indicates that he began with a percutaneous test. If that was the only method used, then for scratch, puncture or prick tests, you should report 95004 (Percutaneous tests [scratch, puncture, prick] with allergenic extracts, immediate type reaction, including test interpretation and report, specify number of tests).

However, your physician’s reference to subsequent “subq” testing suggests that he also used intracutaneous (intradermal) testing with the percutaneous testing. If so, then you should consider reporting either 95017 (Allergy testing, any combination of percutaneous [scratch, puncture, prick] and intracutaneous [intradermal], sequential and incremental, with venoms, immediate type reaction, including test interpretation and report, specify number of tests), or 95018 (Allergy testing, any combination of percutaneous [scratch, puncture, prick] and intracutaneous [intradermal], sequential and incremental, with drugs or biologicals, immediate type reaction, including test interpretation and report, specify number of tests). To choose between these two codes, you will need to clarify with the physician whether he was using venoms (95017) or drugs or biological (95018).

If you were coding for intradermal tests only, then you would choose the appropriate code from 95024-95028 (Intracutaneous [intradermal] tests …). Select code based on the type of test and the allergens noted in the descriptor. However, as noted, this does not appear to be the case in your example.