Know about the Vital Immunology Billing and Coding guidelines

As an immunology specialist, you read and evaluate a patient’s immunology and allergy history. You also examine to determine the right antigens that need to be used and interpretation of all results. However, the truth is that running an immunology practice can be exhausting as immunology billing comes with a unique set of challenges. To maintain a thriving immunology center, you need to have a thorough understanding of immunology billing guidelines as it ensures maximized reimbursements from various payers. When it comes to keeping a seamless revenue cycle for your practice, following the frequently used immunology billing and coding guidelines is crucial.

Frequently used immunology billing and coding guidelines:

• You should not perform allergy testing on the same day as allergy immunotherapy because two different billing codes must not be reported together. Immunology physicians are not supposed to perform diagnostic tests but they should report and interpret the test results.

• Your coding team should only use Evaluation and Management codes when an appropriate significant and separately identifiable E/M service is performed. When it is appropriate, use modifier -25 with the E/M code as it indicates the separately identifiable service. If you report E/M services, you should keep the medical documentation of separately identifiable services in the medical record.

• Allergy testing uses codes 95004 to 95078, which are standard in the MFPS database as individual tests. When billing for these tests, you need to record how many times each test is done on the same patient. For example, if an allergist performs 10 intracutaneous tests, you would use the appropriate billing code and enter '10' in the 'units' field to show that 10 tests were done. The total payment is calculated by multiplying the number of tests by the payment for one test.

• Additionally, the interpretation and reporting of the tests are included in these codes. You can also charge E/M service codes with allergy codes if the service is significant and separate from the testing. In such a case, you need to apply modifier 25.

• You cannot bill a patient’s insurance company for certain services as they are known as “Not-covered Services” in immunology billing.

Now, you need to know about the non-covered services-

• Sublingual intracutaneous and subcutaneous provocative and neutralization testing and neutralization therapy for food allergies

• Challenge ingestion food testing is not effective for diagnosing rheumatoid arthritis, depression, or respiratory disorders. Therefore, using it for these conditions is not reasonable or necessary, and you won't receive payment for it.

• Cytotoxic leukocyte tests for food allergies

The truth is that your main focus should be ensuring optimal care for your patients instead of focusing on the complex immunology billing coding responsibilities. This is exactly where a renowned revenue cycle management company like Sunknowledge can make your life convenient by taking care of your end-to-end billing cycle. As the nation’s leading immunology billing company, Sunknowledge has enabled many immunology practices to significantly improve their overall revenue while cutting down the operational costs by up to 80%.