The Surprising Truth About Same-Day Office Visit & Skin Test Billing

Generally, allergy immunotherapy treatments are not performed on the same day as allergy testing in most medical practices. However, there are common circumstances in which your allergy practice may want to do so. Coding guidelines for these cases are hard to follow. 

Official CPT coding guidelines say that “evaluation and management (E&M) codes reported with allergy testing or allergy immunotherapy are appropriate only if a significant, separately identifiable service is administered.” If doing so, modifier 25 would be utilized.

In short, yes, your practice can bill for E&M services alongside a procedure under certain circumstances. If evaluation and management codes are used, you must provide precise medical documentation of the separate service. 

Read More: CPT S4042: How to Maximize Revenue With S-Codes & Procedure Combos

Understanding E&M Medical Coding for Allergy

To clarify the confusion surrounding the topic, you must remember that E&M procedures “are assigned a global period of 000, 010, 090, XXX, YYY, ZZZ, or MMM.” These global periods reflect limitations on how E&M billing codes can be used following a procedure. 

While these global period designations place hard restrictions on whether E&M coding and modifier 25 are appropriate, the “XXX” designation is the one exception to the rule because it applies to procedures “performed by physicians” and which involve “inherent pre-procedure, intra-procedure, and post-procedure work” every time they are performed. As it turns out, many allergy procedures fall under this XXX global period designation. 

This means that allergy procedures aren’t subject to the same strict rules as other procedures under other global period designations:

“With most “XXX” procedures, the physician may, however, perform a significant and separately identifiable E&M service on the same date of service, which may be reported by appending modifier 25 to the E&M code. Appending modifier 25 to a significant, separately identifiable E&M service when performed on the same date of service as an “XXX” procedure is correct coding.”

What are Evaluation & Management (E&M) Codes? 

Evaluation & management codes represent procedures that evaluate or manage a patient’s health. A wide range of healthcare professionals use these codes across many types of follow-up procedures—especially after minor or major surgery. 

E&M CPT codes can be found between 99202 to 99499.

What is Modifier 25? 

According to the American Medical Association, “Modifier 25 is used to indicate that a patient’s condition required a significant, separately identifiable evaluation and management (E&M) service above and beyond that associated with another procedure or service being reported by the same physician or other qualified health care professional (QHP) on the same date.”

Read More: How to Prepare for Cigna’s Modifer 25 Changes

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