Primary Care Coding Alert

Question: A patient saw our provider for an allergy test. While there, the doctor counseled the patient about giving up smoking. When we billed for this, we were denied the 95004. What did we do wrong?

Louisiana Subscriber

Answer: When you bill 99406 (Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes) or 99407 (Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes) with 95004 (Percutaneous tests (scratch, puncture, prick) with allergenic extracts, immediate type reaction, including test interpretation and report, specify number of tests), the counseling is bundled into the test. That’s because CPT^® does not allow you to use evaluation and management (E/M) service codes “for test interpretation and report,” which is otherwise a part of the service outlined in the allergy test code’s descriptor.

However, National Correct Coding Initiative (NCCI, or CCI) edits assign a modifier indicator of 1 to the pair, with 99406 or 99407 being the column two code. This means that you will need to append a modifier to the counseling code. CPT^® guidelines for the Allergy and Clinical Immunology codes state that “If a significant separately identifiable E/M service is performed, the appropriate E/M service code, which may include … preventive medicine services (99381-99429), should be reported using 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).”