Dermatology Coding Alert

Published on Fri Oct 08, 2004 PDF

Don't bypass modifier -25 or else forfeit pay for patch tests

If you've missed out on patch test reimbursement, look to the documentation for specifics on how many units the dermatologist administered during the test and any E/M services he provided.

Use the following steps to walk yourself through all the proper stages of reporting 95044 (Patch or application test[s] [specify number of tests]).

Step 1: Make sure you bill for office visits

Before you can submit a complete claim for patch tests, you must look at the documentation to make sure the dermatologist included details on the office visit he provided after applying the patch tests, coding experts say.

For example: A new patient comes to your practice with a red, itchy rash on her arm. The dermatologist makes an initial diagnosis of nonspecified contact dermatitis (692.9, Contact dermatitis, NOS).

Next step: After thorough examination, the dermatologist applies the patch tests the same day and asks the patient to return in 48, 72, and 96 hours for readings.
 
You should report 95044 because the dermatologist applied the patch tests, says Pamela J. Biffle, CPC,  CCS-P, an independent consultant in the Dallas/Fort Worth area and an American Academy of Professional Coders instructor.

You should also bill for the E/M services the dermatologist provides to the patient, Biffle says. You should determine the most appropriate E/M code (99201-99215) to report based on the scope of the examination and the key components the dermatologist covers with the patient.

Don't forget: You have to append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to your E/M code to notify the payer that the dermatologist performed an initial evaluation that led him to complete patch testing on this patient. (Look to page 75 for a checklist to help you determine modifier -25.)

Exception: When the dermatologist administers multiple patch tests, he will usually apply the patches to the patient's back for more surface area. Once the dermatologist applies the patch tests, the patient cannot take a shower until after the dermatologist reads the results.

But let's say the patient has a date that evening and asks to have the dermatologist administer the patch test on a different day because she has to take a shower before her date. So she arranges to come back in two days for the dermatologist to apply the patch tests.

When the patient returns to your practice, Biffle says, the nurse applies the patch tests. You shouldn't report an E/M service because the dermatologist did not provide any advice to the patient. You should only report 95044 for the patch test application.

Step 2: Each unit matters, so bill for every unit

When the dermatologist administers patch tests, he applies several patches on the patient to test for his reaction to various allergens.

Therefore, think of each test as an individual procedure because carriers do, and you should bill accordingly, says Patricia Tinker, CPC, clinical practice manager in the department of dermatology at Yale University School of Medicine in New Haven, Conn.

Red flag: If the dermatologist places 24 patches on a patient, carriers will reimburse your practice for 24 tests, but you have to include this information on your claim because carriers will always underestimate.

Hint: Bill your units in block 24G on your CMS-1500 form.

Extra: You can also take a few precautions, Biffle says, to avoid overlooking billing the units in the future: