Allergen coding 86003

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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?
 

CodingKing

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Single line 36 units. There is no MUE on the code but its possible payer may have an edit. I found one plan that limited to 30 per year.
 

CodingKing

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No modifier needed. That would be more for codes that don't say "per or each" in the description or repeat of the same allergen. I had this one provider who kept adding 76 repeat procedure on "each 15 min" codes its like, no doc you didn't do the same test twice it just took 30 min instead of 15.
 
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emunoz

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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?
Do you know if this code is covered by Medicare?

Thanks!
 

CodingKing

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Depends, Check to see what the LCD says for your MAC.

For example L33261 - First Coast Service Options, Inc):


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· Patients who cannot be safely withdrawn from medications that interfere with skin testing (such as long-acting antihistamines, tricyclic antidepressants).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.

Or

L34313 - Noridian Healthcare Solutions, LLC

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.
 
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emunoz

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Thank you for this information! I'm looking for Medicare Part B is Texas.

I checked on Novitas Fee schedule and $0.00 was listed. Would that mean that it isn't a covered code?
 

tpadmasree@gmail.com

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We are getting denials for qty we bill even though we bill as one claim item for RAST panel, 86003(X26, X30, X42 etc) for different payors. Medicare paid for 86003 X 26 without any problem. Of course we are not using any kind of modifiers like 59 or 91 So my questions are
1: we got denial 86003 X 42,for quantity issue, can we just change the quantity to 26 and rebill or is there any preferred procedure ?
2: Where can I find the allowable quantity details for different payors like Medicare, Gateway, Highmark, Amerihealth etc
Padma
 
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