Allergy and Immunology Coding Services

Getting reimbursed on time for procedures has increasingly become a challenge for Allergy and Immunology (A&I) practices across the US. A quagmire of complex codes and payer guidelines lead to repeated denials, revenue shortfalls and compliance issues. In response, practices and providers have gravitated towards dedicated allergy and immunology coding services to get around administrative and regulatory challenges.

Before we get to how our coding service for allergy and immunology practices transforms revenue cycles, let us briefly look at the challenges.

Challenges in Coding for Allergy and Immunology

The introduction of molecular components over the last two decades has caused exceptional growth in allergy diagnosis and immunotherapy. As a result, coding and documentation have become more complex and comprehensive. But this is not the only challenge in coding for immunotherapy or allergy testing.

  • Complexity of diagnoses: Allergy and Immunology involves diverse conditions with subtle variations. Misinterpretation can lead to incorrect coding, affecting revenue and even appropriate treatment.
    For example, Immunoglobulin (Ig)E antibody tests, used to detect and monitor the reaction of the immune system to allergens have now become prevalent. These are covered under HCPCS (Healthcare Common Procedure Coding System) codes J1459 to J1599 and should be billed with relevant Group 1 ICD-10-CM Codes that support medical necessity.

    Solution: Two decades of experience in offering coding services for Allergy and Immunology practices across the US, speaks for our competence in accurately coding for complex diagnoses.

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  • Specificity of codes: The ICD-10 coding system’s limitations in capturing the nuances of complex A&I diagnoses results in insufficient detail creating ambiguity and hindering the chances of getting reimbursed. On the other hand, a shift to ICD 11 or further revisions of the International Statistical Classification of Diseases (ICD) may exacerbate the complexity.
    In this medical niche, there are hundreds of relevant CPT (Current Procedural Terminology)/ HCPCS codes under sections such as Allergy and immunology, Remote Therapeutic Monitoring, Miscellaneous Services, Evaluation and Management (E/M) Services, Online Digital Services, Telephone Services, Inter-professional Telephone/Internet/EHR Consults, Remote Patient Monitoring & Care Management Services.
  • Dynamic testing procedures: Advancements in testing, like component-resolved diagnostics and oral food challenges, introduce new complexities in allergy and immunology medical coding.

    Complex tests like the Immuno Solid-phase Allergen Chip may be considered for coverage in a few years. Without clear guidelines and ever evolving code sets, this may cause confusion and coding errors.

    Solution: Our constant attention to new and ground-breaking procedures and testing methodologies ensures that we can foresee future additions by CMS.

On a related note, a 2020 survey by the American College of Allergy, Asthma & Immunology (ACAAI) found that 30% of attendees cited oral food challenges as the most confusing allergy testing coding topic.

(Source: American College of Allergy, Asthma, and Immunology)

  • Documentation accuracy: Detailed physician notes and their proper documentation are crucial for accurate coding. They help avoid coding errors and compliance issues leading to potential financial penalties for incorrect coding.

    Solution: Our coding teams use the latest in AI (Artificial Intelligence) driven automation tools and document management systems (DMS) to ensure accuracy and compliance with payer guidelines. Zero coding errors and proper documentation help prevent claim denials.

Besides these technical hurdles, there are three primary challenges that we effectively address.

  • Lack of trained specialists: The United States has been battling with a large gap between demand and supply of trained healthcare professionals. This includes expert coders with knowledge of coding for A&I. Healthcare facilities also suffer from a high turnover ratio which forces them to invest additional staff hours in recruitment and training.

    Solution: Partnering with us gives you access to a large pool of trained and certified medical coders with thorough knowledge of coding for Allergy and Immunology practices. We select, train, retrain and manage certified medical coders and billers so you do not have to.

    This scale, speed and accuracy helps your operations grow while still remaining flexible to changes in patient volumes.

  • Cost consideration: It is simply impractical for Immunotherapy practices or labs that test for allergies or immunology departments to hire, train, and maintain a sufficiently large team of coders.

    Solution: Thanks to our large pool of trained resources and the economics of scale, we get to offer the lowest per FTE (Full-Time Employee) cost in the industry. You no longer need to worry about paid time-offs (PTO), the Family and Medical Leave Act (FMLA) or other regulations that reduce productivity. When you outsource Allergy and Immunology Coding Services, your practice can better utilize its trained, in-house experts for critical operational and clinical considerations.

  • Staff Burnout: Relying on in-house staff causes problems for immunology practices across the world, not just in the US. Medical staff being compelled to focus on documentation instead of patient care not only limits your operation, wastes resources, raises costs and leads to staff burnouts.

    Solution: By outsourcing to allergy and immunology coding services, in-house staff can remain engaged in their core competency – patient care. Allergy and Immunology Coding support has been shown to rapidly reduce staff burnout in Immunology practices. Our expert medical billers and coders and streamlined processes alleviate staffing issues and optimize your revenue cycle.

We cover various disciplines within our Immunology billing and coding services, including:
Classical Immunology

  • Clinical Immunology
  • Developmental Immunology
  • Immunotherapy
  • Diagnostic Immunology
  • Evolutionary Immunology
  • Reproductive Immunology, and more

Dedicated coding support for allergy and immunology practices

As a trusted partner for practices and providers across the US, we ensure that you never have to look up CPT codes for allergy skin testing / sequential intracutaneous tests or antigen therapy services / allergen immunotherapy injections.

Outsource to our Allergy and Immunology Coding Services for unmatched precision, cost savings and excellent payer relations along with other advantages:

  • Our coders deliver error-free charge sheets within agreed TAT provided by the client
  • 100% HIPAA compliance
  • 100’s of client referrals across A&I, DMEPOS, HME (Home Medical Equipment), Surgery, Radiology Urgent care Centers, Radiology centers, Anesthesiology & Emergency Room Services.
  • $1-3 million liability insurance support for any errors of omission & commission under Hiscox/Geico
  • All our coders are ICD-10 certified (CPC)
  • 99% medical coding accuracy
  • Complete billing and coding support for immunology and allergy practices
  • Dedicated accounts receivable and denial management support
  • Highest productivity metrics among Allergy and Immunology coding companies

To know more about how we can help your practice thrive, schedule a free, no-obligation call with our experts now.

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