Medical Economics - August 25, 2011 - (Page 33)
have allergies. “Many had vasomotor rhinitis or had triggers that were irritants, like cigarette smoke or weather changes. The testing allows us to ensure that patients who don’t need allergy medications aren’t taking them and that those who do need them are on the right ones.” When allergens are identiﬁed, he says, patients are taught how to avoid or minimize exposure to them. Blood tests can be used to identify food allergies and determine how allergic a patient is to each one identiﬁed.
Twenty percent of patients in the average primary care practice have allergies. Skin prick and in vitro blood tests are approved methods for identifying allergies. Immunotherapy often is effective for patients whose allergies are year-round.
courses on allergy testing and evaluation. These courses cover topics such as administration and interpretation of allergy tests and initiation of immunotherapy, as well as common indicators for allergy testing, best practices for screening, and solutions to immunotherapy problems. UAL also oﬄers training to physicians who contract with the company.
Most public and private insurance plans pay for the oﬀce visit and the lab costs associated with both skin prick and in vitro blood testing. Some IMMUNOTHERAPY plans may cover blood tests only when “If a patient suﬄers from allergies all Most insurance plans skin tests cannot be performed, as year or does not respond to treatment will pay for the of ce visit and lab costs with medication or by avoiding the almight be the case with a patient with associated with allergy lergen, we recommend immunotherapy,” extensive eczema, or one who cannot treatment. Gonzalez says. “We’ve found that imbe taken oﬄ antihistamines, antidepresmunotherapy signiﬁcantly reduces the sants, steroids, or other drugs that may number of emergency department visits interfere with skin test accuracy. for allergy-induced asthma as well as The initial visit with an in-depth the incidence of secondary infections. In addition, history can be upcoded to 99214, and insurance also patients miss less work than they did prior to begin- can be billed for the follow-up oﬀce visit to get the ning the treatment.” blood test results, Scholl says. Skin testing can be The percentage of patients who choose to start billed using code 95004 or 95010 with ICD-9 codes immunotherapy varies by time of year, according for the presenting problem, such as allergic rhinito Hollis. “If the testing is done during a well-care tis, atopic dermatitis, or sinusitis. Visits to receive visit, 15% of patients may start immunotherapy. If or monitor immunotherapy also are covered. UAL it’s allergy season, 60% will begin the program.” advises the practices with which it works on the apFor patients who choose to proceed with immupropriate way to code and bill testing and treatment notherapy in practices using UAL, the UAL technifor each payer. cian custom formulates an antigen therapy designed Neither method for allergy testing has signiﬁcant to desensitize each patient to the allergens identistart-up costs. UAL typically charges practices a ﬁed during testing. An initial course of treatment ﬁxed monthly fee for skin prick testing. Immunois typically 1 year; patients may notice results in as CAP blood test costs vary with the number of tests little as 3 months, and 85% can be cured or fully performed. desensitized in 5 years, Gonzalez says. “The technician also mixes the medication, PRACTICE BENEFITS educates patients about immunotherapy and safety, “Adding allergy testing and immunotherapy has shows them how to use the [epinephrine injection], helped practice revenue tremendously,” Gonzalez and answers their questions” she says. says. “As a result of increased revenue, we were able PCA and most other primary care practices that to successfully compete with hospital-owned pracuse blood tests generally refer patients who need tices and hire additional physicians. We added more immunotherapy to allergists. About 15% of imeducated nursing staﬄ, which increased the quality munotherapy treatments in the United States are of care we provide and our patients’ satisfaction prescribed by PCPs today, Hollis says. with our practice. Speciﬁc training is not required to use either the “It’s been good for our patients and good for our skin prick or the in vitro blood testing model for practice.” allergy testing and immunotherapy. Several continuing medical education providers oﬄer 1- to 3-day Send your feedback to email@example.com.
MedicalEconomics.com August 25, 2011
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