Pulmonology Coding Alert

Question: A patient had a methacholine challenge test and a skin test done on the same day. I billed 95004 x 65 for the skin test in addition to 94070 and 95070 for the methacholine challenge test. The insurance company rejected 95070 because the number of allergy tests had been met. Why is code 95070 classified as an allergy test? And is anyone else getting this rejection for this code?

Virginia Subscriber

Answer: It is not clear why CPT classifies 95070 (Inhalation bronchial challenge testing [not including necessary pulmonary function tests]; with histamine, methacholine, or similar compounds) as an allergy test. It clearly is not an allergy test. Code 95070 tells the payer that the physician administered methacholine (or histamine) as a bronchial challenge.

There is no physician work involved in administering methacholine, but there are technical charges that you should report in addition to code 94070 (Prolonged postexposure evaluation of bronchospasm with multiple spirometric determinations after antigen, cold air, methacholine or other chemical agent, with subsequent spirometrics), which are necessary to measure the response to the methacholine.

If the physician uses an aero-allergen for bronchial challenge, you may also report 95071 (... with antigens or gases, specify) in addition to 94070 to measure the response.

In the case of pulmonary testing, since the administration code only represents "technical" services performed in a facility setting, the facility should report 95070. Some insurers may deny the "technical" service reported by the physician in a facility setting, citing a place-of-service discrepancy.