EM Coding Alert

Question: Following allergy testing, the physician meets with the patient to go over the results. The physician requests that we submit an E/M code in addition to the allergy testing. Is this allowed?

Montana Subscriber

Answer: The physician should not be billing for an E/M service to go over the test results following allergy testing. Inclusive in the patient’s allergy testing is time with the patient to review the results of the testing. For confirmation of this, you should look no further than the following CPT® guidelines located in the Medicine chapter at the beginning of the allergy testing procedures (95004-95071):

“Do not report E/M services for test interpretation and report. If a significant, separately identifiable E/M service is performed, the appropriate E/M service code should be reported using modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service).”

This means that if your physician wants to submit a separate E/M visit alongside the allergy testing, the diagnostic reasoning must be distinct from that of the allergy testing.