TTcpc
Guru
Hello,
Our pediatric allergy practice has started doing peanut desensitization visits and are looking for opinions on how to best capture this. The patients present to the office with a suspected peanut allergy per symptoms/reactions after eating peanuts/peanut containing products. They undergo an oral food challenge to determine the level of reaction or if any reaction. Once a patient is deemed to have a peanut allergy, they may then start weekly visits where they will do one of several options take the Palforzia capsule or eat a small amount of a peanut containing product (usually peanut butter) and they are monitored in the office for approximately one hour.
Per the guidelines from the AAAAI and Palforzia, the first visit is billed as an oral food challenge if one has not been done prior. Since there is no code that exists for these at this time , the following visits are to be billed as E/M based on time and here is where our debate starts. Per the E/M codes the time must be spent on/related to that specific patient's care. They are doing multiple patients (anywhere from 2-4) at the same time so they are not spending time on the patient care of a specific patient during one continuous session. So even thought the patient is there being "monitored" for one hour, the provider (usually the PA) is in and out of the patient's rooms as well as the nurse trained in monitoring for allergic reactions. It's not as difficult if the patient has a reaction as the provider will be in the room treating the reaction and monitoring their clinical status for stabilization.
Any thoughts/opinions welcomed!
Thank you in advance
Our pediatric allergy practice has started doing peanut desensitization visits and are looking for opinions on how to best capture this. The patients present to the office with a suspected peanut allergy per symptoms/reactions after eating peanuts/peanut containing products. They undergo an oral food challenge to determine the level of reaction or if any reaction. Once a patient is deemed to have a peanut allergy, they may then start weekly visits where they will do one of several options take the Palforzia capsule or eat a small amount of a peanut containing product (usually peanut butter) and they are monitored in the office for approximately one hour.
Per the guidelines from the AAAAI and Palforzia, the first visit is billed as an oral food challenge if one has not been done prior. Since there is no code that exists for these at this time , the following visits are to be billed as E/M based on time and here is where our debate starts. Per the E/M codes the time must be spent on/related to that specific patient's care. They are doing multiple patients (anywhere from 2-4) at the same time so they are not spending time on the patient care of a specific patient during one continuous session. So even thought the patient is there being "monitored" for one hour, the provider (usually the PA) is in and out of the patient's rooms as well as the nurse trained in monitoring for allergic reactions. It's not as difficult if the patient has a reaction as the provider will be in the room treating the reaction and monitoring their clinical status for stabilization.
Any thoughts/opinions welcomed!
Thank you in advance