2020 Medicare E&M data for allergy/immunology
How does your coding distribution for Evaluation and Management (E&M) services compare to other allergists? Medicare publicly reports specialty-specific E&M utilization data each year, which they use to identify providers who are overcoding. But this data is also useful if you want to know how your coding compares to your peers. Keep in mind the E&M coding rules changed in 2021, so while it’s interesting to look at the 2020 data, the distribution may well change this year given the new rules.
2020 Medicare E&M code usage for allergy/immunology is summarized below, and despite the pandemic and the emphasis on telemedicine, the distribution is similar to recent years. For new patient visits, the most common code used by allergists was a level 4 at 57% of the time. Level 3 was the next most common, at 34%. Not surprisingly, levels 1 and 2 were infrequently used, and level 5 was used less than 7% of the time.
| New Patient E&M Code | Allergy/Immunology 2020 Medicare Usage | Allergy/Immunology 2020 Medicare Utilization % by Code |
|---|---|---|
| 99201 | 332 | 0.2% |
| 99202 | 3,055 | 2.2% |
| 99203 | 46,539 | 34.0% |
| 99204 | 77,711 | 56.8% |
| 99205 | 9,097 | 6.7% |
| Total | 136,734 | 100.0% |
| Source: Medicare Part B Physician/Supplier National Data CY2020, E&M Codes for Allergy/Immunology | ||
For existing patient visits, level 3 was the most common at 48%, followed by level 4 at 40%. Levels 1, 2 and 5 were used infrequently.
| Existing Patient E&M Code | Allergy/Immunology 2020 Medicare Usage | Allergy/Immunology 2020 Medicare Utilization % by Code |
|---|---|---|
| 99211 | 26,511 | 4.0% |
| 99212 | 31,185 | 4.8% |
| 99213 | 317,825 | 48.4% |
| 99214 | 262,630 | 40.0% |
| 99215 | 17,980 | 2.7% |
| Total | 656,131 | 100.0% |
| Source: Medicare Part B Physician/Supplier National Data CY2020, E&M Codes for Allergy/Immunology | ||
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. And now that E&M coding can be based on either medical decision making or time, coding distributions may change going forward.
If you or your billing staff needs an overview or refresher on allergy/immunology coding, we encourage you to check out the College’s recently revamped 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.
