Internal Medicine Coding: Don't Forget Office Visits For Initial & Follow-up Patch Tests

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When your internist carries out a patch test and follow-up for a patient, do not let some of the calculations go past your notice. Count each patch and any extra Evaluation/Management services to round off a complete claim.


Cover office visit code


A just-in patient comes with a red, itchy rash on his arm. The internist makes an initial diagnosis on non-specified contact dermatitis (692.9, Contact dermatitis and other eczema; unspecified cause). The doctor then applies patch tests and asks the patient to return in 48, 72 and 96 hours for readings.


Report it: As your doctor applied the patch test, you will report 95044 (Patch or application test[s] [specify number of tests]). You will also bill for any evaluation/management service the internist provided for the patient. As you are filing a claim for a new patient, choose the proper E/M code from 99201- 99205 (Office or other outpatient visit for the evaluation and management of a new patient …).


Change it: Add modifier 25 to your E/M code to notify the payer that the doctor ...
... carried out an initial evaluation that led her to complete patch testing on the patient. You can also consider adding modifier 25 when coding an E/M service.


Count every unit


When conducting a patch test, the doctor applies various patches on the patient to test for his reaction to various allergens. Payers consider each test as an individual procedure; as such you should calculate accordingly when billing.


Tip: Bill your units in block 24G of the CMS-1500 form according to the number of allergens tested. Teach your staff to double check the number of units on the charge ticket, and educate your doctor to document the correct units. Front desk staff can also help by asking the internist how many patch she administered.


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