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billing clia waved allergy test

Omalari Posted Sat 22nd of June, 2013 01:03:48 AM

how do I bill for clia wave allergy testing CPT code '86003'?

SuperCoder Answered Mon 24th of June, 2013 12:28:51 PM

When the pediatrician orders in vitro tests, such as RAST (radioallergosorbent tests), FAST (fluorescent allergosorbent tests) or ELISA (enzyme–linked immunosorbent assay), you should use 86003 (Allergen specific IgE; quantitative or semiquantitative, each allergen). To report the lab code, your office must analyze the specimen, not merely send it to a lab. Most carriers, commercial and Medicare, will not pay
for these tests except under certain conditions. Insurers may cover the tests when the patient is a child under 4.


Some insurers may allow you to report allergy testing for 20 allergens, such as 86003 (Allergen specific IgE; quantitative or semiquantitative, each allergen) x 20. But you should check with payers before billing more than 14 units. Many insurers limit the number of allergy tests allowed based on conservative medical practices, which call for testing a judicious amount of allergens at a time. Allergy screening test literature supports and the American Academy of Otolaryngic Allergy (AAOA) recommends screening and billing for no more than 14 antigens (plus the appropriate controls) for an initial allergy evaluation according to the AAOA Coding Advisory. In most geographic regions, a range of up to 14 allergens is sufficient to check the most prevalent molds, dust components, grasses, trees, animals, and weeds. Therefore, if your otolaryngologist performs additional tests, such as 86003, 95004 (Percutaneous tests [scratch, puncture, prick] with allergenic extracts, immediate type reaction, specify number of tests), 95024 (Intracutaneous [intradermal] tests with allergenic extracts, immediate type reaction, specify number of tests) or 95027 (Intracutaneous [intradermal] tests, sequential and incremental, with allergenic extracts for airborne allergens, immediate type reaction, specify number of tests), carriers that limit the number of tests billed at one time or within a certain number of years may deny the extra tests. Practices that often exceed carrier limits may be flagged for an audit, so make sure to ask payers for their current allergy payment practices.

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