Understanding Important CPT Codes for Allergy & Immunology Billing Services
Well-done coding sets the foundation for billing of allergy and immunology practices. From diagnostic testing to treating and following up, Current Procedural Terminology (CPT) codes play a pivotal role in ensuring proper reimbursement, and reducing claim denials. Allergy and immunology services are highly different when it comes to CPT codes because of various therapies both the specialties offer.
Common CPT Codes for Allergy & Immunology Billing Services
A deep understanding of CPT codes is important to handle various allergy and immunology services. These codes cover various skin allergy tests, intradermal testing, venom testing, and allergen immunotherapy injections. Making sure that each service rendered is assigned the most accurate code is crucial to a smooth claims submission. Below are some codes that are used commonly and its applications:
Allergy Testing Codes:
Due to its wide range of services, dermatology billing comes with distinct challenges. These include:
- 95004: Percutaneous skin testing (scratch tests) for immediate allergen reaction.
- 95024: Intradermal skin tests, used when percutaneous tests yield inconclusive results.
- 95076 & 95079: Ingestion challenge testing, used to confirm food or drug allergies.
Each of the above categories of dermatology practice requires billing codes and documentation that is different from one another. Also, cosmetic procedures are usually not covered in insurance plans. For this very reason, dermatologists in the USA have to balance cash payments and insurance reimbursements effectively for their dermatology practice’s financial stability.
Allergy Treatment Codes:
- 95115: Single injection for allergen immunotherapy (allergy shot)..
- 95117: Multiple injections for allergen immunotherapy.
- 95165: Preparation of antigen serum for immunotherapy, billed per dose.
Follow-up and Evaluation Codes:
- 99213: Office or outpatient visit for an established patient (low complexity).
- 99214: Office visit for an established patient with moderate complexity.
- 99204:New patient evaluation, often required before initiating treatment plans.
Categorization of codes based on service type helps streamline the billing process and improve coding accuracy.
Key Differences in Billing: Allergy Shots, Testing, and Oral Therapies
Each type of allergy treatment requires distinct billing considerations.s
Allergy Shots are often delivered weekly. This requires diligent documentation to bill CPT codes like 95115 or 95117. Code 95165 is used to bill for preparation of antigens, and precise reporting of these is crucial since it is billed per dose.
Allergy Testing includes codes like 95004 and 95024, which involves multiple allergens. Clear documentation for the number of tests conducted avoids underbilling of the services rendered. Another important thing to remember is that, differentiate between skin testing and ingestion challenge testing to avoid coding errors.
Oral Immunotherapy (OIT) may not always fall under the traditional immunotherapy codes but detailed documentation can help support reimbursement under E/M codes like 99213 or 99214. Coding reflects the level of physician supervision during an OIT session. This impacts reimbursement.
Each service type has distinct coding needs. Knowing these differences is essential for proper claim submission and faster reimbursements.
How to Avoid Claim Rejections When Reporting CPT Codes for Allergy and Immunology Billing?
Accurate reporting significantly reduces claim denials and streamlines revenue cycle.
- Provide detailed documentation that aligns with the billed CPT codes. If billing for the code 95004, which is used for percutaneous tests, include the number of allergens tested and the results.
- Different payers have different rules for allergy and immunology services. Always review payer policies codes like 95165 that confirms proper reporting and reimbursement.
- Billing for a more complex service that is provided (upcoding) or a less complex service (undercoding) leads to audits and penalties. Always billing based on the complexity of service delivered helps in accurate coding.
- Some CPT codes require modifiers for additional specificity. Using modifiers -25 for a significant, separately identifiable E/M service provided on the same day as another procedure.
- Having a billing and coding team that is updated with the latest CPT codes changes, and payer policies help reduce mistakes. Partnering with expert allergy and immunology billing service providers like Instapay Healthcare Services keeps your practice ahead of coding challenges.
Choosing Instapay Healthcare Services for Allergy & Immunology Billing
Dealing with the complex CPT codes in allergy and immunology billing may feel overwhelming alongside managing the practice and patient care. There should be no shame in taking help from experts because medical billing and coding is no one-person job.
Instapay Healthcare Services specializes in:
- Allergy and immunology billing and coding
- HIPAA compliance
- CPT codes along with ICD-10 and HCPCS systems
- Payer policies
- Insurance follow-ups
- End-to-end billing and coding processes
- Claim submissions with minimized claim denials and rejections
Understanding and accurately applying CPT codes is essential for allergy and immunology billing and coding. By breaking down common codes, recognizing the differences in treatment types, and implementing strategies to avoid claim rejections, your allergy and immunology practice can achieve smoother revenue cycles and improved profitability.
Partner with Instapay Healthcare Services today to take the guesswork out of medical billing and coding. Contact us to learn more about how we can support your practice!
