Allergy Codes

Nitric oxide expired gas determination (95012), or the measurement of eNO, has not been assigned a physician work RVU. Therefore, this would be billable only in an outpatient setting, not in a facility. This code is slowly gaining acceptance as a diagnostic tool in allergist practices. Medicare has the code listed as a payable code, but many other payers may not recognize it as a payable code. The 95012 code is used when determining the NO expired gas determination. A patient’s eNO level is measured using specialized equipment and under the direct supervision of a clinician. The patient is instructed to exhale, place the testing device in the mouth and inhale to lung capacity. The clinician monitors the patient to ensure a steady compliance inhalation, and the device, which uses a chemiluminescence gas analyzer and integrated software to measure numbers of NO molecules at very low concentrations, determines the patient’s eNO level. The reimbursement forthis code varies by payer. Some payers consider the eNO determination code to be experimental and, therefore, the patient to be responsible for the charge.

If a procedure or service for pulmonary function studies is not described in the CPT book under one of the listed codes, then the appropriate manner to code for the services would be to submit notes and use the unlisted procedure code 94799. Respiratory muscle strength measurements are reported correctly with this code as well.

Allergy Testing Codes. E/M services codes may be charged in addition to the allergy testing codes as long as the service is a significant and separately identifiable service. Like the pulmonary function codes, allergy testing codes include a professional and a technical component. In most instances in which the allergist has his or her own practice and employs the staff to perform services, the entire global code will be charged without any modifier to indicate a split between the professional and technical component. If you are a hospital based employed physician, your code would be only for the professional component since the hospital would be coding for the technical component if performed by hospital staff. 

Percutaneous tests are coded for non-biologic/nonvenom allergenic extracts with the 95004 code. This code includes the cost of performing the tests as well as the cost of the allergenic extracts being tested. The multi-test device is not a separately billable item. The intradermal test for non-biologic/non-venom allergenic extracts is coded as 95024. For either test, you would charge for the number of tests as well as for the controls. The interpretation and report of the test are included as part of the value of the allergy testing code. Therefore, if an E/M service is charged on the same day as the test, the E/M service must be significant and separately identifiable beyond the definition of the testing code. If the history and exam were only to enable the testing, the evaluation and management code would not be separately billable. Code 95017 is for allergy testing with any combination of percutaneous or intradermal methods, sequential, and incremental with venom antigens. The tests should have an immediate type reaction and include the interpretation and report of the tests. The number of tests should be specified to include all tests performed with either method.

Code 95018 is for allergy testing to any drugs or biologics. This code also should have an immediate type reaction and includes the interpretation and report of each test. The method is sequential and incremental for percutaneous and/or intradermal methods.

The appropriate code for performing intra-cutaneous tests that are sequential and incremental for airborne allergensis 95027. Some third-party payersrecognize this code as an experimental code and will not cover it for their beneficiaries. 

Code 95028 is for intra-cutaneous (intradermal) tests with allergenic extracts, delayed type reaction, and it also includes the reading and interpretation of the tests.

If a patient is being patch tested, the appropriate code is 95044 for the number of patches placed on the patient. When the patient returns for either interpretation or removal of the patches, it is appropriate to charge an E/M level of established patient care. 

 The testing component for the methacholine test is coded 95070. Again, this code can be used with methacholine or other compounds that demonstrate a bronchial challenge. If antigens or gases are used, then the appropriate code would be 99071.