Wiki 99213 & 95004

[bkerste]

I'm kind of new to allergy testing. Is it ok to bill an E&M with testing code 95004? The HPI note starts out with "here for allergy testing to help identify. . ." & the OV prior to this visit talks about the patient coming in for testing when she can be off her antihistimine for 7 days. So are we allowed to bill the E&M, even though it was a planned procedure?

 

[salsur@msn.com]

Per LCD L30471

Medicare Regulations and Coding Guidelines for Jurisdiction 8; Indiana & Michigan.
1. Evaluation and management codes reported with allergy testing or allergy immunotherapy are appropriate only if a significant, separately identifiable service is administered. When appropriate, use modifier -25 with the E&M code to indicate it as a separately identifiable service. Obtaining informed consent is included in the immunotherapy. If E & M services are reported, medical documentation of the separately identifiable service should be in the medical record.
2. Allergy testing is not performed on the same day as allergy immunotherapy in standard medical practice. These codes should, therefore, not be reported together. Additionally, the testing becomes an integral part to rapid desensitization kits (CPT code 95180) and would therefore not be reported separately.

You can also refer to Allergy and Clinical Immunology section in the 2013 CPT, pg. 529.

 

[chriskhans]

We encounter this scenario all the time with the allergist I work for.
The medical decision making has already been counted in the previous appointment when the patient was scheduled to come back for allergy testing. Unless there is something significantly separate that comes about at the skin testing appointment, I do not bill an office visit I bill strictly for 95004.

 

[ahunemuller]

New patient & allergy testing

What about billing a new patient code 99201-99205 with allergy testing. If that's the only reason they have been referred but the MD has never seen them before can we bill both? My initials thoughts are no because I've read many places it doesn't matter if they are new or not, it still has to be seperately identifiable.