We now have two years of allergy/immunology Medicare E&M coding data following the E&M rule change in 2021, with E&M codes based on time or medical decision-making. We were curious: how did allergist coding patterns change following the new rules? Medicare publicly reports specialty-specific E&M utilization data each year, which they use to identify providers who are overcoding. But this data can also tell us how allergy/immunology E&M coding patterns change over time, as well as help you see how your coding distribution for E&M services compares to other allergists.
Medicare E&M code usage for allergy/immunology for the years 2022, 2021 and 2020 is summarized below. Coding pattern shifts have been gradual as allergists learned how to incorporate the new rules. However, there has been a small but clear increase in level 4 coding and a corresponding decrease in level 3 coding for both new and existing patients over the past two years. For new patient visits, level 4 visits increased 3 percentage points to just under 60% in 2022. Level 3 visits decreased the same amount to 31.2%. The most common code used by allergists in all three years was a level 4, with level 3 being the next most common.
Allergy/Immunology Medicare E&M Distribution –
Existing Patients 2020-2022
| New Patient E&M Code | 2022 Utilization % | 2021 Utilization % | 2020 Utilization % |
|---|---|---|---|
| 99202 | 1.1% | 2.0% | 2.2% |
| 99203 | 31.2% | 32.3% | 34.1% |
| 99204 | 59.9% | 57.4% | 57.0% |
| 99205 | 7.8% | 8.3% | 6.7% |
| Total | 100.0% | 100.0% | 100.0% |
| Source: Medicare Part B Utilization CY2021 E&M Codes by Specialty, Medicare Part B Utilization CY2020 E&M Codes by Specialty and https://data.cms.gov/summary-statistics-on-use-and-payments/physiciansupplier-procedure-summary/data | |||
Coding shifts for existing patient visits were more marked. Level 4 usage increased by 5 percentage points to 45.0% in 2022, and surpassed level 3 as the most common E&M code used by allergists. Level 3 coding dropped from 48.4% in 2020 to 43.9% in 2022. Levels 1, 2 and 5 continue to be used infrequently.
Allergy/Immunology Medicare E&M Distribution –
Existing Patients 2020-2022
| Existing Patient E&M Code | 2022 Utilization % | 2021 Utilization % | 2020 Utilization % |
|---|---|---|---|
| 99211 | 3.2% | 3.4% | 4.0% |
| 99212 | 4.1% | 4.6% | 4.8% |
| 99213 | 43.9% | 45.7% | 48.4% |
| 99214 | 45.0% | 42.8% | 40.0% |
| 99215 | 3.7% | 3.5% | 2.7% |
| Total | 100.0% | 100.0% | 100.0% |
| Source: Medicare Part B Utilization CY2021 E&M Codes by Specialty, Medicare Part B Utilization CY2020 E&M Codes by Specialty and https://data.cms.gov/summary-statistics-on-use-and-payments/physiciansupplier-procedure-summary/data | |||
It will be interesting to see if these coding pattern shifts continue in favor of higher codes as allergists get more comfortable with the new E&M coding rules.
You may want to pull your own historical coding data from your practice management system to see how it compares to the average Medicare coding distribution for allergists/immunologists. Keep in mind, however, that every practice has a different demographic of patients, and your own experience, especially with non-Medicare patients, may not be directly comparable to the Medicare average.
If you or your billing staff needs an overview or refresher on allergy/immunology coding, we encourage you to check out the College’s updated Coding Toolkit. We have explanations of the 2021 E&M coding rules, plus expert advice on coding for 95165, allergy testing, immunotherapy, procedures, OIT and more. Our Coding FAQ database should be the first place you look when you have an allergy coding question!
Special thanks to Robert Ellis, the CFO of the Carolina Asthma & Allergy Center, for sharing the 2022 data cited in this article.
