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Pulmonology Coding Alert

News Brief:

CMS Clarifies Allergy Policies

Published on Mon Oct 01, 2001

In August 2001, CMS clarified two important policies for the diagnosis and treatment of allergies.
 
The first applies to the billing for allergy injections given by the staff in a pulmonologists office. In this situation, Medicare incident to rules apply. One requirement of these rules is that a physician must be physically present in the office at the time of the injection. Medicare has emphasized that the name of the supervising physician in the office suite at the time of the injection must be shown in Box 31 of HCFA Form 1500. But the supervising physician does not have to be the physician who ordered the immunotherapy; he can be the usual physician seen by the patient.
 
For a practice billing under a group number, this clarification may have a slight effect when calculating the productivity of individual physicians, but this rule must be followed.
 
The second concerns the prohibition of billing CPT codes 95004 (percutaneous tests [scratch, puncture, prick] with allergenic extracts, immediate type reaction, specify number of tests) and 95010 (percutaneous tests [scratch, puncture, prick] sequential and incremental, with drugs, biologicals or venoms, immediate type reaction, specify number of tests). According to communication between the Joint Council of Allergy, Asthma and Immunology (JCAAI) and CMS, this edit is being reversed and these two codes can be billed on the same day.
 
This change is retroactive to Jan. 1, 1999, so check for any denials within this time frame. The next Correct Coding Initiative (CCI version 7.3) announcing this modification will be issued Oct. 1, 2001. After this date, any denials for this combination of codes qualifying for the retroactive reimbursement can be resubmitted to Medicare. Practices that are members of JCAAI can contact that office if they have any problems realizing appropriate retroactive reimbursement.
 
Also, the JCAAI informed its members that billing 95024 (intracutaneous [intradermal] tests with allergenic extracts, immediate type reaction, specify number of tests) and 95010 on the same day was never prohibited. The assumption that the CCI edit included these two codes was incorrect. Thus, check your records to make sure you have received proper reimbursement for this code combination.

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