How To Use CPT Code 95004

CPT 95004 is a code used for percutaneous allergy tests with allergenic extracts, including test interpretation and report; this article will cover the code description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples.

1. What is CPT 95004?

CPT 95004 is a medical billing code used to describe a specific type of allergy testing procedure. This code is utilized when a healthcare provider performs percutaneous tests (scratch, puncture, or prick) with allergenic extracts to determine which substances trigger an allergic reaction in a patient. The code also includes the interpretation of the test results and the creation of a report.

2. 95004 CPT code description

The official description of CPT code 95004 is: “Percutaneous tests (scratch, puncture, prick) with allergenic extracts, immediate type reaction, including test interpretation and report, specify number of tests.”

3. Procedure

The 95004 procedure involves the following steps:

1. The healthcare provider selects the allergenic extracts to be tested based on the patient’s history and symptoms.
2. The patient’s skin is cleaned and marked to identify the test sites.
3. Small amounts of allergenic extracts are introduced into the epidermis and non-vascular superficial dermis through scratch, puncture, or prick on the skin.
4. The provider waits for a predetermined interval of time (e.g., 15 minutes) to observe any immediate type reactions.
5. The provider visually checks the target area for any visible wheal and flare reaction, which indicates a potential allergy to the specific allergen.
6. The provider interprets the test results and creates a report detailing the findings.

4. Qualifying circumstances

Patients who are eligible to receive CPT code 95004 services are those who present with symptoms suggestive of an allergic reaction or have a history of allergies. The healthcare provider may also consider performing this test on patients with a family history of allergies or those who are at risk for developing allergies due to environmental or occupational exposure.

5. When to use CPT code 95004

It is appropriate to bill the 95004 CPT code when a healthcare provider performs a percutaneous allergy test with allergenic extracts to diagnose or confirm the presence of allergies in a patient. This code should be used when the provider is responsible for interpreting the test results and creating a report based on the findings.

6. Documentation requirements

To support a claim for CPT 95004, the following information should be documented:

• Patient’s history and symptoms suggestive of allergies
• Reason for performing the allergy test
• Specific allergenic extracts used in the test
• Test sites and method of allergen introduction (scratch, puncture, or prick)
• Observation period and any immediate type reactions noted
• Interpretation of test results and report creation

7. Billing guidelines

When billing for CPT code 95004, it is essential to follow the appropriate guidelines and rules. Some tips for billing this code include:

• Ensure that the documentation supports the medical necessity of the allergy test.
• Specify the number of tests performed in the claim.
• Use modifier 59 when billing for multiple tests to indicate that they are distinct and separate services.
• Check payer-specific guidelines for any additional requirements or restrictions.

8. Historical information

CPT 95004 was added to the Current Procedural Terminology system on January 1, 1993. There have been updates to the code description since its addition:

• Code Changed on 01-01-2008: “Percutaneous tests (scratch, puncture, prick) with allergenic extracts, immediate type reaction, specify number of tests.”
• Code Changed on 01-01-2013: “Percutaneous tests (scratch, puncture, prick) with allergenic extracts, immediate type reaction, including test interpretation and report by a physician, specify number of tests.”

9. Similar codes to CPT 95004

There are several other codes related to allergy testing that differentiate from CPT 95004:

1. CPT 95010: This code is used for intracutaneous (intradermal) tests with allergenic extracts, immediate type reaction, including test interpretation and report.
2. CPT 95015: This code is for percutaneous tests using venom, immediate type reaction, including test interpretation and report.
3. CPT 95024: This code is for intracutaneous (intradermal) tests using allergenic extracts, delayed type reaction, including reading.
4. CPT 95027: This code is for inhalation bronchial challenge testing (not including necessary pulmonary function tests) with antigens or gases.
5. CPT 95028: This code is for intracutaneous (intradermal) tests with photo-patch tests, including reading when performed.

10. Examples

Here are 10 detailed examples of CPT code 95004 procedures:

1. A patient with a history of seasonal allergies undergoes percutaneous testing with 10 allergenic extracts to identify specific allergens causing their symptoms.
2. A child with a suspected food allergy undergoes percutaneous testing with five food allergens to determine the cause of their allergic reactions.
3. An adult with a history of allergic reactions to insect bites undergoes percutaneous testing with three insect allergens to identify the specific insect responsible for their reactions.
4. A patient with a family history of allergies undergoes percutaneous testing with 15 allergenic extracts to assess their risk of developing allergies.
5. An individual with a suspected drug allergy undergoes percutaneous testing with two drug allergens to determine the cause of their allergic reactions.
6. A patient with a history of allergic contact dermatitis undergoes percutaneous testing with 10 allergenic extracts to identify the specific allergens causing their skin reactions.
7. An individual with a suspected latex allergy undergoes percutaneous testing with latex allergens to confirm their allergy.
8. A patient with a history of allergic rhinitis undergoes percutaneous testing with eight allergenic extracts to identify the specific allergens causing their symptoms.
9. An adult with a suspected mold allergy undergoes percutaneous testing with five mold allergens to determine the cause of their allergic reactions.
10. A patient with a history of allergic asthma undergoes percutaneous testing with 12 allergenic extracts to identify the specific allergens triggering their asthma symptoms.