Q.Should physicians report CPT code 95027 by antigen or per dilution (test or stick)? 95027Intracutaneous (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
A. The change for the code descriptor for CPT code 95027 was documented in the American Medical AssociationsCPT® Changes 2003: An Insider’s View. Formerly describing skin end point titration testing, CPT Code 95027 now refers to intradermal dilutional testing. It should be reported by the number of sticks or tests performed per allergen at the various levels of dilution. For example, if a physician administers 10 allergens at 4 concentration levels for each antigen, he or she would report this as 95027 with 40 units of service. According to American Medical Associations Current Procedural Terminology CPT® 2008 Changes, CPT code 95027 does not include history and physical services. Furthermore, CPT code 95027 includes the test interpretation and report by a physician, so you should not report these separately with Evaluation and Management (E/M) Services. If the physician performs a distinct and separately identifiable E/M, on the same date of service as the intradermal dilutional tests, he or she can report this with an appropriate E/M code, appending modifier 25 –Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Serviceto it.
Approved November 2009
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CPT for ENT articles are a collaborative effort between the Academy’s team of CPT Advisors, members of the Physician Payment Policy (3P) workgroup, and health policy staff. Articles are developed to address common coding questions received by the health policy team, as well as to clarify coding changes and correct coding principles for frequently reported ENT procedures. These articles are not intended as legal, medical, or business advice and are not a guarantee of reimbursement. The information is also not meant to serve as the definitive or sole authority on billing and coding issues. The applicability of AAO-HNS billing and coding guidance for a particular procedure, must be determined by the responsible physician in light of all the circumstances presented by the individual patient. You should consult with your own advisors as well as Medicare or private carriers in making any decisions about how to bill and code particular services or procedures.