47.1 Most Important Information

Each physician or advanced practice provider is responsible for his/her own coding practices and accuracy. This chapter contains a guide of commonly used allergy Current Procedural Terminology (CPT) codes that are current as of publication, but may change with future revisions of CPT code terminology after this book is published. Be sure to verify with the most current CPT publications to ensure coding accuracy.

47.2 Billing and Coding

When adding allergy to a new or existing practice, the allergist should meet with the billing office staff and explain all the new procedure codes they will be encountering. It may be necessary to add billing staff to accommodate the increase in claims volume or update any billing/coding or electronic medical record software. Insurance companies should also be contacted so that fee schedules and covered services are spelled out clearly and obtained in writing. Most of the procedures billed by the allergy care provider are “incident to” services and are paid under the physician’s fee schedule. An “incident to” service must be part of the patient’s normal course of treatment. The physician must have performed the initial service and must remain actively involved in the treatment course. Although the physician does not have to be in the room where the service is performed, he or she must be in the immediate area providing direct supervision. This must also be clearly stated in the patient’s record. The most common CPT^®codes used for allergy services are discussed further.

95004: This code is used for skin prick testing for airborne or food allergens. The number of units assigned to this code corresponds to the number of antigens and controls tested. The reporting of the results and the interpretation by the physician is included in this code.

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