Family Practice Coding: For Complete Patch Test Coding, Count Every Patch And Office Visit

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When your family physician carries out a patch test and follow-up for a patient, do not let some of the calculations go unnoticed. Count each patch and any extra evaluation and management services to round out a complete claim and see your bottom line soar by about $6 per patch.


Include office visit code


A new patient visits your office with a red, itchy rash on his arm. The family physician makes an initial diagnosis of non-specified contact dermatitis (692.9, Contact dermatitis and other eczema; unspecified cause). Then the doctor applies patch tests and enquires the patient to come back for readings in 48, 72, and 96 hours.


Report it: Since your doctor applied the patch test, you will report 95044. You will also bill for any evaluation & management service the family practitioner provided for the patient. Since you are filling a claim for a new patient, choose the proper evaluation & management code from 99201-99205 (Office or other outpatient visit for the E&M of a new patient …).


Change it: Add modifier 25 (Significant, ...
... separately identifiable E&M service by the same doctor on the same day of the procedure or other service) to your evaluation & management code to notify the payer that the physician performed an initial evaluation that led her to complete patch testing on the patient. You can also think about reporting modifier 25 while coding an E/M service.


Count every unit


While conducting a patch test, the doctor applies various patches on the patient to test for his reaction to various allergens. Payers take each test as an individual procedure; therefore you should calculate accordingly when billing. Even though 95044 carries only 0.18 total RVUs, the national average Medicare facility and non-facility fee is $6.12 (based on the national conversion factor of 33.9764). Your payment can grow considerably depending on the number of patches applied.


Here's a tip: Bill your units in block 24G of the CMS-1500 form as per the number of allergens tested. Teach your staff to double check the number of units on the charge ticket, and educate your physician to document the correct units. Front-desk staff can also aid by asking the family physician how many patch tests she administered.


Report Multiple evaluation & management for follow-up


Just as you report 95044 for each patch test applied, you will submit an evaluation & management code for each follow-up visit. In the above instance, the patient returns to the office in 48, 72, and 96 hours. Each of those visits will be coded using an evaluation & management code. Since the doctor is now seeing an established patient, choose your evaluation & management code from 99211-99215 (Office or other outpatient visit for the evaluation and management of an established patient …).


Exception: If a nurse reads the patch tests, stay away from higher-level E/M codes. Family physician is onsite when the staff member reads the results. The doctor should be able to make a more definitive diagnosis once she reads the patch test results.


For more on this and for other specialty-specific articles to assist your family practice coding, sign up for a good medical coding resource like Coding Institute.