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Allergy injections and diagnostic tests
CPT Assistant, December 2007 Page: 9 Category: Coding Consultation
CPT Coding for Allergy Injections and Allergy Diagnostic Tests
Allergy injections are reported using CPT codes 95115 for a single injection and 95117 for two or more injections. These codes describe the administration (injection) of the allergenic extract when the extract provision or preparation of the extract is not included in the code descriptor. They do not include the provision or preparation of the extract. Codes 95115 and 95117 are intended to be reported one time, regardless of the number of injections administered. These services are typically performed by a nurse and do not include physician work. If the physician performs an evaluation and management (E/M) service on the same day as an injection, the physician should document the service and report the appropriate level E/M service code. In cases when there is no physician history or exam performed but the nurse must consult with the physician as to whether the patient should receive the injection and whether dosage adjustments are required (eg, the patient is ill or reports a reaction to the last injection), CPT code 99211 would be appropriate.
Allergy Diagnostic Tests
95004 Percutaneous tests (scratch, puncture, prick) with allergenic extracts, immediate type reaction, including test interpretation and report by a physician, specify number of tests
95024 Intracutaneous (intradermal) tests with allergenic extracts, immediate type reaction, including test interpretation and report by a physician, specify number of tests
95027 Intracutaneous (intradermal) tests, sequential and incremental, with allergenic extracts for airborne allergens, immediate type reaction, including test interpretation and report by a physician, specify number of tests
Effective January 1, 2008, the descriptors for the allergy diagnostic test codes (CPT codes 95004, 95024, and 95027) have been modified to clarify that the service includes "test interpretation and report by a physician." In addition, Centers for Medicare & Medicaid Services (CMS) now recognizes physician work for CPT codes 95004, 95024, and 95027. Furthermore, the Allergy and Clinical Immunology guidelines have been modified to indicate that when reporting any allergy testing on the same day as a significant, separately identifiable E/M service, modifier 25 must be appended to the E/M service code.
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