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How does your E&M coding compare to other allergists?

| October 19, 2020

How does your E&M coding compare to other allergists?

Have you wondered how your coding distribution for Evaluation and Management (E&M) services compares to other allergists? Medicare publicly reports specialty-specific E&M utilization data, 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.

2019 Medicare E&M code usage for allergy/immunology is summarized below, and the distribution is similar to recent years. For new patient visits, the most common code used by allergists was a level 4 at 58% of the time. Level 3 was the next most common, at nearly 33%. Not surprisingly, levels 1 and 2 were infrequently used, and level 5 was used less than 8% of the time.

E&M Code
(new patient)
Allergy/Immunology 2019 Medicare UsageAllergy/Immunology 2019 Medicare Utilization % by Code
992012260.1%
992023,4422.0%
9920357,87632.8%
99204101,94057.8%
9920512,7897.3%
Total176,273100.0%
Source: Medicare Part B Physician/Supplier National Data CY2019, E&M Codes for Allergy/Immunology

For existing patient visits, level 3 was the most common at 49%, followed by level 4 at 41%. Levels 1, 2 and 5 were used infrequently.

E&M Code
(existing patient)
Allergy/Immunology 2019 Medicare UsageAllergy/Immunology 2019 Medicare Utilization % by Code
9921127,1883.4%
9921231,0563.9%
99213383,54048.7%
99214323,81441.1%
9921522,4722.9%
Total788,070100.0%
Source: Medicare Part B Physician/Supplier National Data CY2019, 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.

Remember that E&M coding changes will take effect on January 1 of 2021. Starting next year, coding can be based on either medical decision making or time, so coding distributions may change going forward. However, even with these changes, it’s useful to understand how your own coding compares to your peers.

If you or your billing staff needs an overview or refresher on allergy/immunology coding, we encourage you to attend one of the College’s Annual Meeting coding sessions. On Friday morning we have Practice Management in a Changing Landscape – Billing and Coding Update, and on Sunday morning there is a session on Coding and Government Relations.

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