How to Handle Same-Day Testing & Treatment in Allergy Asthma and Immunology Billing

Allergy Asthma and Immunology Billing Services face unique challenges when testing and treatment occur on the same day. Managing these encounters requires correct coding, modifier use, and documentation to prevent payer denials. This blog highlights practical ways to handle same-day testing and treatment through better preparation, accurate coding, proper modifiers, and the use of advanced RCM services for allergy and asthma to improve claim success and reimbursement.

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Managing the Challenges of Same-Day Allergy Asthma and Immunology Billing

Same-day testing and treatment in allergy and immunology billing services often lead to coding and claim issues. Overlapping CPT codes for skin testing, immunotherapy, or asthma evaluations cause payers to flag claims as duplicates. Missing modifiers such as 25 or 59 and inconsistent documentation further increase denials.

Studies show up to 22% of same-day allergy billing claims face rejections due to coding or record errors. To overcome this, clinics rely on RCM services for allergy and asthma and expert allergy billing services to manage coding, link diagnosis codes, and follow payer-specific rules.

“The real test in allergy billing isn’t in the diagnosis—it’s in the details of documentation.”

— Healthcare Finance Journal, 2025

Preparing for Same-Day Testing and Treatment in Allergy & Asthma Practices

Preparation for same-day services starts with pre-encounter verification and clinical coordination to reduce billing errors and denials. Before the visit, staff should confirm insurance coverage, documentation requirements, and payer-specific authorization rules for testing and immunotherapy. Aligning clinical and billing workflows ensures that codes, diagnoses, and procedures match payer policies. Many practices now use allergy billing with automated verification tools to check eligibility, validate modifiers, and identify potential coding conflicts before submission.

Preparation Step	Purpose	Example Action
Verify insurance eligibility	Prevent denials	Use payer portals to confirm coverage
Obtain pre-authorization	Ensure compliance	Request documentation for allergy testing
Review patient history	Avoid duplication	Check previous tests in EMR

Applying Correct Coding for Same-Day Allergy Testing & Immunotherapy

Proper coding is essential for same-day billing in allergy and asthma practices. Each test or treatment must use the correct CPT and ICD-10 codes to reflect the service performed. Correct code selection in allergy and immunology billing services supports medical necessity and helps prevent denials or claim bundling.

1. CPT Codes for Allergy Testing Performed on the Same Day

Use CPT 95004–95078 for skin, patch, and intradermal testing:

• 95004–95024: Percutaneous and intradermal tests

• 95027–95028: Bronchial or nasal challenge (for asthma evaluation)

• 95044–95078: Patch or complex tests

Each code must reflect the method and number of allergens tested, listed separately from treatment codes to avoid bundling. To learn expert strategies for precise coding and compliance, check out our blog on Mastering Allergy and Immunology Billing Essentials.

2. CPT Codes for Immunotherapy and Injection Services

For same-day therapy, use 95115–95117 for injections and 95145–95170 for extract preparation:

• 95115: Single injection

• 95117: Two or more injections

Document extract type, dosage, and formulation precisely. Immunotherapy codes should follow testing codes to reflect the clinical order.

3. Linking CPT Codes With ICD-10 Diagnoses

Proper linkage proves medical necessity:

• J30.9: Allergic rhinitis, unspecified

• J45.909: Unspecified asthma

• T78.40XA: Allergy, unspecified

Using allergy and immunology billing services with code validation prevents “unrelated service” denials in same-day claims.

4. Coding for Extract Preparation and Dosage Details

When preparing allergen extracts, record quantity, concentration, and type.

• 95165: Single-dose vial

• 95170: Multi-dose vial

RCM services for allergy and asthma automate dosage mapping to reduce coding errors and rejections. For more details, refer to the official Medicare guidelines on allergy and immunotherapy billing and coding.

5. Documenting Time, Method, and Procedure Details

Provider notes must specify number of allergens, dose, and testing method. Billing teams should verify all coded services appear in the record. Integrated allergy billing services link EMR notes to claims for consistent charge capture and audit compliance.

Using Modifiers for Combined Allergy Testing and Treatment Claims

Modifiers clarify multiple services performed on the same day for allergy and asthma care. Use Modifier 25 for a separate E/M service and Modifier 59 for distinct procedures like skin testing and immunotherapy. Without proper modifiers, payers may assume duplicate billing and deny claims. Practices should educate their teams to apply these correctly or consider outsourcing allergy and immunology billing services for expert management.

Modifier	Description	Use Case
25	Separate evaluation service	Used with E/M and testing codes
59	Distinct procedural service	Used for treatment on the same day
76	Repeat procedure	Used if testing is repeated during visit

Documenting Same-Day Services to Support Allergy & Asthma Billing Claims

Detailed documentation is vital for proper allergy and asthma billing. Providers should record the number of allergens tested, dosage, timing, and related diagnosis to show medical necessity. Missing or inconsistent records can lead to denials or audits. Using EMR templates that capture CPT codes, results, and injection details ensures consistency. Many practices rely on RCM services for allergy and asthma to review documentation and confirm that coded services match clinical records before claim submission.

If you are interested to read more about allergy & immunology, please have a look at this blog on ‘‘How Outsourcing Improves Allergy and Immunology RCM Efficiency’’.

“If it’s not documented, it’s not billable—and that’s the golden rule of medical billing.”

— Healthcare Finance Journal, 2025

Submitting Claims for Allergy Asthma & Immunology Services

Submitting claims for allergy, asthma, and immunology services requires precise coding and clear documentation. Each claim should include correct CPT and ICD-10 codes, proper modifiers, and evidence for same-day testing and treatment.

Before submission, verify payer rules on same-day coverage and allowable code combinations. Using claim scrubbers helps catch errors early, while RCM services for allergy and asthma optimize submissions and follow-ups to reduce denials and improve payment turnaround.

Claim Step	Tool/Action	Benefit
Code review	Claim scrubber	Detects coding inconsistencies
Eligibility check	Clearinghouse verification	Prevents mismatched insurance
Batch submission	Automated RCM software	Reduces manual errors

Managing Denials Specific to Testing and Treatment Visits

Same-day testing and treatment often face denials from code overlap or missing documentation. Billing teams should track denial reasons and address them promptly. Outsourced RCM specialists for allergy and immunology billing helps identify recurring issues through analytic reports and optimize claim corrections for faster resolution.

Training Billing Teams for Better Same-Day Allergy Billing Practices

Well-trained billing teams manage same-day allergy and asthma claims more efficiently. Regular updates on coding, modifiers, and payer rules help prevent errors and denials. Many practices partner with RCM services for allergy and asthma to access continuous education and compliance support without overloading internal staff.

Implementing Technology to Improve Allergy Asthma & Immunology Operations

Specialized systems using the best revenue cycle management for immunology also detect coding errors, link CPT–ICD combinations, and monitor same-day services, improving efficiency and accelerating payment cycles for busy allergy and asthma practices. Specialized systems using the best revenue cycle management for immunology also detect coding errors, link CPT–ICD combinations, and monitor same-day services, improving efficiency and accelerating payment cycles for busy allergy and asthma practices.

 Staying Updated With Coding and Payer Policy Revisions

Staying informed about coding and payer updates is crucial in allergy, asthma, and immunology billing. CPT or ICD-10 changes can affect how same-day testing and immunotherapy are reimbursed, while payer rules for modifiers and documentation often shift. Billing teams should monitor payer notifications and CMS guidelines or work with experts who track these revisions to prevent rejections and maintain consistent claim approvals.

Strengthening Allergy and Immunology Billing for Dual-Service Visits

Efficient billing for dual-service visits depends on preparation, coding precision, and continuous process improvement. Whether managed internally or through outsourcing allergy and immunology billing services, the goal remains the same—error-free claim submission and timely payment.

Handling same-day testing and treatment in Allergy Asthma and Immunology Billing Services requires precision, preparation, and consistency. From coding and modifier use to claim submission and denial management, every step impacts your practice’s efficiency and reimbursement. If your practice is facing challenges with same-day billing or wants to strengthen its allergy and asthma claim process, our team can help. Contact us today to optimize your billing operations and stay focused on providing better care for your patients.

FAQs: Allergy and Asthma Billing

How should allergy and asthma services be coded?+

Use CPT codes 95004–95078 for allergy testing and 95115–95170 for immunotherapy. Pair them with the appropriate ICD-10 diagnosis codes to ensure claim accuracy.

Which modifiers are most important for same-day allergy testing?+

Modifiers 25 (separate E/M service) and 59 (distinct procedural service) are crucial for indicating that allergy testing was distinct from other same-day services, helping avoid bundling denials.

How often should billing teams review coding updates?+

Billing and coding teams should review CPT, ICD-10, and payer policy updates at least quarterly to stay compliant and prevent costly claim rejections.

Can spirometry or asthma assessment be billed with allergy testing on the same day?+

Yes, both services can be billed if medically necessary and separately documented. Use Modifier 25 with the E/M code when an asthma evaluation is performed alongside allergy testing.

Should same-day testing and treatment be billed under one claim or separate claims?+

This depends on payer policy. Some payers prefer combined submissions with correct modifiers, while others require separate claims for allergy testing and treatment services. Always verify payer-specific rules before billing.

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Managing same-day testing and treatment in Allergy, Asthma, and Immunology Billing requires precision, compliance, and the right billing strategy. Our team helps specialty practices assess their current billing processes, identify coding challenges, and implement solutions that reduce denials and improve reimbursement. Fill out the form below to receive a personalized same-day billing and coding review plan customized to your allergy and asthma practice needs.