Allergy and Immunology 101

Man sneezing into bent arm

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Allergy testing can help identify what triggers allergic reactions and prevent serious medical emergencies. The focus of this article is to illuminate the basics of Allergy and Immunology coding requirements.

Allergy Testing

Regardless of testing and allergen type, remember to specify number of tests performed.

  • 95004: Skin Prick testing for environmental allergens and food allergens
    • Environmental allergens: Usually 20-40 tests performed
    • Food allergens: Ranges between one and 80 tests
  • 95017: Venom and Fire Ant Testing

Typically performed if history of serious reaction to fire ants and/or wasps, bees, hornets, yellow jackets. The total number of tests can range from 3 to 25.

  • 95018: Medication Skin Testing

e.g., Penicillin testing, using total of six tests. Number can vary for other medications.

  • 95024: Intracutaneous (Intradermal) (tests with extracts)

This testing is useful if initial skin prick tests are negative. The testing ranges anywhere from 2-11 (IMMEDIATE reaction) tests.

  • 95027: Intracutaneous (Intradermal) tests sequential and incremental (with airborne allergenic extracts) IMMEDIATE type reaction (specify number of tests)
  • 95028: Intracutaneous (Intradermal) tests sequential and incremental (with allergenic extracts) DELAYED type reaction (specify number of tests)

Allergy Immunotherapy

A single dose vial contains a single dose of antigen administered in (1) injection. (specify number of vials)

  • 95144: Allergist’s prep & provision of single-dose vials     Single Dose (specify number of vials)
  • 95120–95134: Complete service codes for the supply of antigen (extract) and allergy injection (specify provision type of allergen and number of injections)
  • 95165: Allergist’s prep & provision of single or multiple antigens (specify number of doses)

A dose is the number of antigen(s) administered in a single injection from a multi-dose vial

Ingestion Challenge Test

  • 95076 – Ingestion challenge test (sequential and incremental ingestion of test items, e.g., food, drug, other substance); Initial 120 minutes of testing
  • +95079 –…; each additional 60 minutes of testing

These services fall under the “past midpoint” concept.

If challenge is stopped prior to 61 minutes to a reaction, CPT 95076 code is not billed. In this case, a return visit (Evaluation and Management) would be reported.

Spirometry

  • 94010 – Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary ventilation.

(Do not report 94010 in conjunction with 94150, 94200, 94375, 94728)

Evaluation and Management and Procedure on Same Day

You may report a separately identifiable E/M (Evaluation and Management) service on the same day as allergy testing or allergy immunotherapy. That said, informed consent is part of the procedure, do not report an E/M if that is the sole purpose for the service. You will need to append modifier -25 on the E/M code when the criteria have been met.

Understanding the bundling rules will make allergy coding less tricky. For more information, check out the CMS Allergy Testing and Allergy Immunotherapy LCD pages linked below. I have also linked their modifier pages below as well.

Resources:

MSHBC MDM and Time E/M + Procedure Articles

AMA Guidelines

NAMAS Table

AAPC Allergy & Immunology Code Page

Allergy Testing

Allergy Immunotherapy

Modifier –25 and Tips

Modifier –26

Modifier –76

Modifier –77