Oct-Nov 00 Part A Bulletin - Medicare

LOCAL AND FOCUSED MEDICAL REVIEW POLICIES
95004: Allergy Skin Tests (continued)
Noncovered ICD-9-CM Code(s)
The following ICD-9-CM codes are noncovered for
procedure codes 95010, 95015, 95024, 95027, 95028, and
95078:
692.5 Contact dermatitis and other eczema due
to food in contact with skin
693.1 Dermatitis due to food
995.60-995.69 Anaphylactic shock due to adverse food
reaction
Noncovered Diagnosis
Food allergies are noncovered for procedure codes
95010, 95015, 95024, 95027, 95028, and 95078.
Coding Guidelines
When coding for allergy skin tests indicate (1) unit for
each test performed. For example, if 18 scratch tests are
performed with allergenic extracts, bill procedure code
95004 indicating 18 units.
Documentation Requirements
Medical record documentation maintained by the
performing physician must clearly indicate the medical
necessity of the service being billed. In addition,
documentation that the service was performed must be
included in the patient’s medical record. This information is
normally found in the history and physical examination
notes, office/progress notes, hospital notes, and/or procedure
report.
Utilization Guidelines
N/A
Other Comments
Terms Defined:
Allergen—any substance that causes manifestations of
allergy.
Allergy—an acquired, abnormal immune response to a
substance (allergen) that does not normally cause a reaction.
Asthma—a disease caused by increased responsiveness of
the tracheobronchial tree to various stimuli.
Sources of Information
N/A
Advisory Committee Notes
This policy does not reflect the sole opinion of the
contractor or Contractor Medical Director. Although the
final decision rests with the contractor, this policy was
developed in cooperation with the contractor’s Advisory
Committee, which includes representatives from numerous
societies.
Start Date of Comment Period
N/A
Start Date of Notice Period
10/01/2000
Revision History
Revision Number: 1
Start Date of Comment Period: N/A
Start Date of Notice Period: 10/01/2000
Oct/Nov 2000 Bulletin
Revised Effective Date: 08/31/2000
Explanation of Revision: Deletion of CPT code 95004
from the list of codes that are
noncovered for food allergy
testing.
Revision Number: Original
Start Date of Comment Period: 02/21/2000
Start Date of Notice Period: 06/01/2000
June/July 2000 Bulletin
Original Effective Date: 07/17/2000 �
38 The Florida Medicare A Bulletin
October/November 2000