Are you leaving money on the table because you’re not billing for all the services you provide? Review the overlooked allergy-related CPT codes below to see if any of them apply to your practice. You may find hidden revenue for work you’re already doing! Details for most codes are provided in a linked article or resource; please read these to make sure you understand how and when to bill these codes, as well as the documentation required for each one.
G2211 – Complexity add-on code
This is an add-on code for use with office-based E/M codes. Allergists may bill code G2211 if they are managing the ongoing care for a patient’s complex or serious disease or condition. This code has been underutilized by physicians; an analysis of the first three quarters of 2024 Medicare claims data shows G2211 was reported with only 10.5% of office visits, far below CMS’ projected utilization of 38% of all office visits.
99446, 99447, 99448, 99449 and 99451 – Interprofessional consults
These codes cover physician consults via telephone, internet or the EHR to PCPs, hospitalists, other physicians or NPs/PAs for treatment advice for their patients.
ACAAI: Coding for interprofessional consults
96160, 96161 – Asthma Control Tests
These codes allow allergists to get reimbursed for certain standardized asthma assessment instruments, including Asthma Control Tests (ACTs).
ACAAI: 96160 & 96161 – When can allergists use them?
98016 – Established patient, brief audio-only visit
This code for Brief Synchronous Communication covers a single five- to 10-minute medical audio-only discussion initiated by an established patient. It cannot be related to a previous E/M service with the last seven days or lead to one in the next 24 hours. CMS and UHC cover this code, as well as other commercial carriers.
AMA Digital Medicine Clinical Scenarios: Coding Handbook – review scenario #4
99421 – Online digital evaluation & management service (patient portal messaging)
This code covers an online E&M patient-initiated inquiry with cumulative physician time of 5-10 minutes for up to seven days. It cannot be related to a previous E/M service with the last seven days or result in a separate E/M visit within seven days.
AMA Digital Medicine Clinical Scenarios: Coding Handbook – review scenario #5
G0136 – Social Determinants of Health (SDOH) Risk Assessment
Code G0136 covers the administration of a patient SDOH Risk Assessment. Any standardized, evidence-based SDOH risk assessment tool that has been tested and validated may be used. Note: when the effects of a patient’s SDOH are significant, it can also increase the level of the patient’s office visit due to increased risk. When using MDM to determine the E/M level, risk may increase due to a diagnosis or treatment significantly limited by SDOH.
ACAAI: Improve patient quality of care and get paid for it
99211 – Educating patients for in-home injections
Practices that provide training for in-home injections (for dupilumab, tezepelumab, etc.) can bill 99211 for a nurse visit with proper documentation. You must indicate that the service is medically necessary. Essential patient education is considered an example of medical necessity. Note, you cannot use an injection code (96372) at the same visit. You must have a physician or NP/PA in the office (not in the room) at the time of service. Be sure to include the following documentation:
- Reason for the “nurse visit” via a plan of care
- Patient’s diagnosis and prescription for medication
- Today’s new education
- Credentials of the face-to-face staff and provider
Make sure you properly document each service you provide, and that all billing criteria are met to avoid denials. And start billing for every service you provide!
