Do you know if this code is covered by Medicare?Does anyone have any knowledge in coding an Allergen panel? We are having to bill 86003 at 36 units, but should we be using modifier 91? If so, do we have to code it out on 36 lines or can we show everything on 1 line?
B. In vitro testing (blood serum analysis): immediate hypersensitivity testing by measurement of allergen-specific serum IgE (CPT code 86003). Special clinical situations in which specific IgE immunoassays may be appropriate include the following:
· Patients with severe dermatographism, ichthyosis or generalized eczema.
· Patients who cannot be safely withdrawn from medications that interfere with skin testing (such as long-acting antihistamines, tricyclic antidepressants).
· Uncooperative patients with mental or physical impairments.
· Evaluation of cross-reactivity between insect venoms (e.g., fire ant, bee, wasp, yellow jacket, hornet).
· As adjunctive laboratory testing for disease activity of allergic bronchopulmonary aspergillosis and certain parasitic diseases.
· Patients at increased risk for anaphylactic response from skin testing based on clinical history (e.g., when an unusual allergen is not available as a licensed skin test extract), or who have a history of a previous systemic reaction to skin testing.
· Patients in whom skin testing was equivocal/inconclusive and in vitro testing is required as a confirmatory test.
Quantitative or semi-quantitative in vitro allergen specific IgE testing (CPT code 86003) is covered under conditions where skin testing is not possible or is not reliable. In vitro testing is covered as a SUBSTITUTE for skin testing; it is usually not necessary in addition to skin testing. The number of tests done, frequency of retesting and other coverage issues, are the same as for skin testing. The indications for using in vitro testing instead of in vivo methods must be documented with the claim.
Examples of indications for in vitro testing include the following:
Patients with severe dermatographism, ichthyosis or generalized eczema;
Patients at increased risk for anaphylactic response to skin testing based on clinical history (e.g., when an unusual allergen is not available as a licensed skin test extract);
Patients unable to discontinue long-acting antihistamines, tricyclic antidepressants, or medications that may put the patient at undue risk if they are discontinued long enough to perform skin tests;
Patients with mental or physical impairments, who are uncooperative; or
Evaluation of cross-reactivity between insect venoms.
The following are noncovered antigens: newsprint, tobacco smoke, dandelion, orris root, phenol, alcohol, sugar, yeast, grain mill dust, soybean dust (except when the patient has a known exposure to soybean dust such as a food processing plant), honeysuckle, fiberglass, green tea, or chalk.