Allergy Testing: Avoid Allergy Testing, Immunotherapy Coding Traps

Accurate coding begins with careful attention to detail, and this is especially critical when reporting allergy testing, immunotherapy preparation, and injection services.

The broad spectrum of allergy tests and treatment modalities often leads to reporting errors or misinterpretation. 

To ensure compliance and process claims accurately, review these frequently asked questions. Here, we provide clear guidance to support accuracy and confidence in coding allergy-related services.

Which Factors Influence Code Selection in Allergy Testing?

The CPT® range for allergy testing (95004–95071) provides multiple options for reporting these services. Code assignment depends on details such as the type of test performed, the substance being tested, and the timing of the reaction.

Code Selection Based on Test Method

In many situations, the code is determined by the nature of the testing itself. For instance, a scratch test may be reported with code 95004 (Percutaneous tests [scratch, puncture, prick] with allergenic extracts, immediate-type reaction, including test interpretation and report; specify the number of tests). For patch testing, the appropriate choice would be 95044 (Patch or application test(s); specify number of tests). Nonsequential intradermal testing, on the other hand, is reported with code 95024 (Intradermal tests with allergenic extracts, immediate-type reaction, including test interpretation and report; specify the number of tests).

Code Selection Based on Substance and Reaction Timing

In other cases, accurate reporting requires considering not only the type of test but also what is being tested and when the reaction occurs. For example, suppose a scratch test is performed to detect allergies to venoms, such as those from bee or wasp stings. In that case, the correct code is 95017 (Allergy testing, any combination of percutaneous and intradermal, sequential and incremental, with venoms, immediate-type reaction, including test interpretation and report; specify the number of tests). If the testing involves drugs or biologicals, the correct code would be 95018 (…with drugs or biologicals, immediate type reaction, including test interpretation and report; specify number of tests).

What Counts Toward Percutaneous Allergy Testing Code Units?

In a percutaneous test, also known as a scratch, prick, puncture, or multitest, the provider applies solutions that help determine whether a patient is allergic to specific substances. A small scratch or puncture is made in the skin, and a drop of the suspected allergen is placed at that site to observe for a reaction.

Interpreting “Specify Number of Tests”

The descriptor for 95004 includes the instruction “specify number of tests.” This refers to the number of allergens tested, not the number of punctures or scratches. The same rule applies to venom testing (95017) and to drug or biological testing (95018).

Counting Substances Tested

Providers often test multiple allergens during one session, sometimes in sets of eight. Common examples during allergy season include substances such as ragweed, oak, maple, and grasses. Each substance tested is counted as a separate unit. For instance, if testing is done for ragweed, oak, and grass, the claim would be reported as 95004 × 3.

Important Exception

Although most CPT® allergy testing codes include the direction to “specify number of tests,” some do not. These codes are reported only once per encounter, regardless of the number of tests performed. For example, 95060 (Ophthalmic mucous membrane tests) includes any number of tests conducted at the same visit.

Is Patch Testing Reported Only Once per Patient?

When an allergist performs a patch test, also referred to as a thin-layer rapid use epicutaneous (T.R.U.E.) test, the correct code to report is 95044. Similar to percutaneous testing, the number of reported units is determined by the number of allergens tested. Each patch applied represents one test.

Reporting Units on the Claim Form

Accurate reporting requires counting the total number of patches used. For example, if 24 patches are applied to the patient’s back, the claim should indicate 95044 × 24, supported by documentation reflecting the number of tests performed. The code descriptor itself reinforces this by stating “specify number of tests.”

Documentation and Compliance

It is crucial to educate healthcare providers and staff on the proper documentation for patch testing. Clear records of the number of patches applied help ensure that claims are neither underreported, which results in lost reimbursement, nor overreported, which could lead to denials or overpayments.

Maximize Accuracy and Reimbursement in Allergy Billing with BillingFreedom

Accurate coding for allergy testing and immunotherapy is essential to avoid claim denials and ensure proper reimbursement. With multiple CPT® codes covering percutaneous, patch, intradermal, venom, and drug testing, precise documentation of the number of tests and proper code selection is critical. BillingFreedom provides expert Allergy & Immunology Medical Billing Services, offering specialized support to manage these complex services and help practices accurately report each test while maintaining compliance.

Our team carefully reviews patient encounters, tracks the exact number of allergens tested, and applies the correct CPT® codes for all types of allergy testing. By partnering with BillingFreedom, practices can streamline claims, reduce coding errors, and ensure reimbursement aligns with the services provided, all while maintaining transparency and adherence to coding guidelines.

For more details about our exceptional medical billing services, please don't hesitate to contact us via email at info@billingfreedom.com or call us at +1 (855) 415-3472. 

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