E/M Code with Allergy Testing

E/M Code with Allergy Testing

March 19, 2020

Question:
At a recent KZA coding course, you discussed being able to charge an office visit after an allergy test if a plan for immunotherapy treatment was discussed. Insurance companies are denying this even if we are using a 25 modifier. How can I get this paid if I use the allergy diagnosis?

Answer:
Be sure the E/M note clearly states “While allergy testing results were provided, the Medical Decision Making to determine a treatment plan encompassed the majority of the visit.” You could also copy the page in the CPT book with the allergy coding guidelines (where it says what’s included in the E/M and what’s not) and highlight the part of the E/M note that shows what was done above and beyond just providing the patient with the testing results.

*This response is based on the best information available as of 03/19/20.

 

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