The Advocacy Council regularly receives queries from members on how to correctly code specific scenarios. Recently we received a request for assistance from a practice that is looking for direction on correct coding for skin testing on the same day as an evaluation and management (E&M) service.
Q: How can we get paid for an office visit on the same day we do allergy testing?
A: There is physician work built into the testing codes, which is why you might receive denials when testing is billed with an E&M – this practice is becoming more prevalent. If your documentation supports separate identifiable services and you’ve used a modifier -25 on the E&M service, you should be paid for both. You should appeal the claim if denied payment.
Following is language you could include in an appeal letter:
To whom it may concern:
The patient in question was a [insert here: complex, new, etc.] patient with the following diagnosis: [insert here]
We billed a [insert level] level E&M code and documented the level of service. In addition, on the same visit, we performed allergy skin testing which is a distinct, additional service that includes significant risk and physician work in the RVU-value of the code.
The RVS Update Committee/Centers for Medicare and Medicaid Services determined a medically necessary E&M service is outside the values built into the testing codes for physician work and decision-making. When appropriate levels of E&M services are met and documented, it should be treated as a separate identifiable service – and not bundled as part of the skin testing.
This sample letter has been supported by the CPT advisor for allergy.
Include copies of your patient chart noting documentation of the E&M and medical necessity for the skin tests.