We now have three years of allergy/immunology Medicare E&M coding data following the rule change in 2021, with E&M codes based on time or medical decision-making. The trend is clear: allergists’ coding patterns have continued to shift in favor of higher E&M codes over the past three years.
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 these services compares to other allergists.
2020-2023 Medicare E&M code usage for allergy/immunology is summarized below. Coding pattern shifts have been gradual as allergists learned how to incorporate the new rules. However, there has been a consistent increase in level 4 coding and a corresponding decrease in level 3 coding for both new and existing patients over the past three years – but the shift for existing patients has been most significant. For new patient visits, level 4 visits increased 4 percentage points to just under 61% in 2023. Level 3 visits decreased the same amount to 29.8%. The most common code used by allergists in all four years was level 4, with level 3 being the next most common.
Allergy/Immunology Medicare E&M Distribution –
New Patients 2020-2023
| New Patient E&M Code |
2023 Utilization % | 2022 Utilization % | 2021 Utilization % | 2020 Utilization % |
|---|---|---|---|---|
| 99202 | 1.0% | 1.1% | 2.0% | 2.2% |
| 99203 | 29.8% | 31.2% | 32.3% | 34.1% |
| 99204 | 60.8% | 59.9% | 57.4% | 57.0% |
| 99205 | 8.4% | 7.8% | 8.3% | 6.7% |
| Total | 100.0% | 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 |
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Coding shifts for existing patient visits were more marked. Level 4 usage increased by close to 8 percentage points to 47.7% in 2023 and is now solidly the most common E&M code used by allergists. Level 3 coding dropped from 48.4% in 2020 to 41.9% in 2023. Levels 1, 2 and 5 continue to be used infrequently – but we are seeing a slight increase in coding for level 5 and a slight decrease in coding for levels 1 and 2.
Allergy/Immunology Medicare E&M Distribution –
Existing Patients 2020-2023
| Existing Patient E&M Code | 2023 Utilization % | 2022 Utilization % | 2021 Utilization % | 2020 Utilization % |
|---|---|---|---|---|
| 99211 | 2.7% | 3.2% | 3.4% | 4.0% |
| 99212 | 3.7% | 4.1% | 4.6% | 4.8% |
| 99213 | 41.9% | 43.9% | 45.7 | 48.4% |
| 99214 | 47.7% | 45.0% | 42.8% | 40.0% |
| 99215 | 4.0% | 3.7% | 3.5% | 2.7% |
| Total | 100.0% | 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 |
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Has your practice been keeping up with these coding changes? 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 2023 data cited in this article.
