Pulmonology Coding Alert

Why 'extensive procedure' designation affects your coding

 You can no longer report allergy test codes 95004-95010 and 95024-95027 together for the same session. The National Correct Coding Initiative (NCCI) edits, version 10.0, which took effect Jan. 1, bundle the codes under a "most extensive procedure" designation.

Learn Which Code Is Most Extensive

In a "most extensive" bundle, the comprehensive code requires more physician work than the component code, coding experts say.
 
So, when your pulmonologist performs procedures such as scratch or intracutaneous tests that are included in the "most extensive procedure" bundle, you can report only the code that NCCI determines is the most extensive, says Carol Pohlig, BSN, RN, CPC, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia.
 
For example, a patient who had past allergies presents with wheezing (786.07). Your physician applies dust, mold and dog dander to skin scratches (95004, Percutaneous tests [scratch, puncture, prick] with allergenic extracts, immediate type reaction, specify number of tests). The tests come back negative. The physician then suspects that the patient has extrinsic allergic alveolitis and uses a scratch test to check for biological or venom allergies (95010, Percutaneous tests [scratch, puncture, prick] sequential and incremental, with drugs, biological or venoms, immediate type reaction, specify number of tests).
 
Because NCCI designates 95010 as the comprehensive or "most extensive procedure" and selects 95004 as the component code, you should report only 95010. And although the physician performed multiple tests for different reasons, you still can't bill for both services if the physician gave the tests on the same day, Pohlig says.
 
If the pulmonologist wanted to bill 95024 (Intracutaneous [intradermal] tests with allergenic extracts, immediate type reaction, specify number of tests) and 95027 (Intracutaneous [intradermal] tests, sequential and incremental, with allergenic extracts for airborne allergens, immediate type reaction, specify number of tests) separately for tests performed during the same session, you could report only 95027. NCCI designates that code as comprehensive and, therefore, the most extensive procedure.

Modifier -59 Use Requires Different Encounters

NCCI allows some leeway for reporting the allergy codes separately. The new edits give both edit pairs (95010 and 95004; 95027 and 95024) a "1" classification, meaning that you could use an NCCI-approved modifier, such as modifier -59 (Distinct procedural service), to unbundle the codes.
 
But if you want to get paid for two allergy tests with modifier -59, you'll have to prove that the physician performed the procedures at separate sessions, Pohlig says.
 
Tip: Because Medicare designates edits 95010-95004 and 95027-95024 as "most extensive procedure" bundles, you should never attempt to unbundle these codes with modifier -59 when the physician performs both tests during the same session.
 
The only way to separately report the codes is for the physician to perform the tests at different sessions.
 
Note, however, that pulmonologists rarely perform two percutaneous or intracutaneous tests under these circumstances.