Many patients would undoubtedly welcome the ability to have multiple conditions, including troublesome allergies diagnosed and treated through the same set of providers, rather than having to travel here and there to one doctor for testing and perhaps another for treatment.
If you’re an Ear, Nose and Throat (ENT) physician, or practice Family Medicine, Internal Medicine or Pediatrics, this might be a good add-on service to offer. For those meeting the criteria and wondering how to begin, here are a few tips as well as some basic coding information to get your practice (and billing department) off to a good start.
ENTs and traditional allergists – some statistics and facts
About 300-400 ENT physicians start out from 120 residency programs annually, with allergy training now required of all ENT residency programs. With an estimated 45 percent of ENT patients suffering from allergies, there may be strong connections between head and neck conditions and allergies.
Asthmatic triggers can lead to additional conditions including:
- Otitis media
- Pharyngitis changes
In 2006, only 34 percent of ENTS offered any sort of allergy services, while today that number is closer to 70 percent. According to the Agency for Healthcare Research and Quality, one out of five people have some sort of allergy, with the number of people presenting with allergy symptoms having doubled since 1995, currently estimated at 50 million. Teaming up with an allergist for referrals or starting testing and treatment as an ancillary service is therefore a good idea – both for your patients as well as a reliable revenue source for the practice.
Testing for allergies often includes:
- Percutaneous (skin prick) test, which introduces an antigen into the skin to produce a response that may take the form of redness and bumps
- Intradermal tests further help quantify the severity of the reactions
- Substances tested as allergens can include foods, mold, pollen, animal dander and related substances
- Between 35–60 allergen panels may be tested, with tests taking between 20 minutes to two hours
- Most states permit allergy testing to be done by an MA or higher, with some testing services able to test on-site
- Manufacturers should be able to help with designing matching panels with region-specific allergens
Testing for penicillin allergies: methods and benefits
Allergies related to the antibiotic penicillin may pose a significant risk to patients who have been prescribed certain antibiotics. Knowing ahead of time whether an allergy is present can help the provider recommend a different course of treatment, as well as spare the patient the possible side effects of a bad reaction.
When the suggested protocol is followed correctly, the penicillin allergy test has a 99 percent rate of success, with a very small chance of anaphylaxis. Testing time normally runs about 1.5 to two hours, with easy diagnostics and manageable supplies. The process may include:
- Skin prick with derivatives and controls of (least sensitive) penicillin
- Intradermal testing employing controls and derivatives of (more sensitive) forms of penicillin
- Oral (confirmation) graded challenge with 250 mg of penicillin
The patient now has any previous antibiotic-related inaccurate diagnoses removed from their records, with the opening of a larger class of broad-spectrum antibiotics. According to Mayo Clinic figures, the cost is lowered for beta-lactums, while reducing antibiotic resistance.
In addition, the practice now has added a new source of revenue and referrals.
What kinds of allergy treatment are usually offered?
Immunotherapy treatment for allergies has been clinically documented as able to reduce or even completely remove allergy symptoms. Patients are able to sharply reduce their intake of traditional allergy symptom-relief medicines, as their immune systems are challenged by the administration of controlled dosing of allergens. Thus, instead of merely addressing the symptoms of a particular allergy, the patient’s own immune system is now able to better meet the problems previously posed by allergens.
What codes are commonly used for allergy testing documentation and billing?
Below is a partial CPT allergy testing fee schedule:
95004 – Percutaneous (MQT) – $6.50
95024 – Intradermal (MQT) $8.00
95027 – Intradermal (SET) $470
CPT Allergy Injection:
95115 – Single $9.00
95117 – Multiple – $10.50
CPT Allergen Preparation:
95165 – Multiple dose $13.00
CPT Penicillin Testing:
95018 – Percutaneous/ Intradermal $19.00
95076 – Oral challenge $118.00
How can allergy testing and treatment affect revenue?
In 2017 alone, 200 providers in 120 practices surveyed reported 107 million patient accounts, with 3.9 million claims for a billing total of $656 million in charges.
Assuming an average of five new patients daily, an estimated 50 percent of those can be expected to have some form of allergies, half of which will likely opt for immunotherapy. Since treatment normally lasts an average of three to five years, assuming a 50 percent compliance rate, monitoring patient health for an additional number of years as necessitated can enhance continuity of care and outcomes.
What does a practice need to know before getting started?
Patient recruitment involving histories of rhinitis or sinusitis, possible allergy to penicillin and allergist referrals
- Staff (Member) Physician oversees allergy protocols while ensuring that all office procedure guidelines are met
- Nurses (in tech capacity) perform skin tests and administer allergy injections
- Office staff to observe patients for possible reactions in waiting area following injections
- Office and billing department ensure that codes / procedures are accurate and compliant with procedure and payer requirements
Monitoring the success of an allergy testing program includes measuring:
- Total number of patients participating, ongoing treatments
- Percentage of billings
What are the benefits of working with a medical billing/ practice management service?
- Assistance with payer contract reviews and negotiations
- Pre-RAC audits
- GPO affiliations
- Highly trained and experienced personnel
- Clinical Decision support