More about Patch testing:
Patch test procedures - a quick summary:
- Take complete and accurate patient histories and perform a physical exam.
Click here for a history form (Acrobat PDF viewer required) - Schedule patient for patch testing and consider the impact of any immunosuppressive medications.
- Provide patient with pre-test instructions, and describe the patch testing process, including the goals and limitations.
- Apply patch test chambers and allergens to the patient's back. Patches must remain dry and in place for 48 hours.
- Remove patches at 48 hours and interpret skin reactions. Schedule subsequent assessments at additional times, such as 72 and 96 hours.
Click here for a blank data form (Acrobat PDF viewer required). (Acrobat PDF viewer required) - Counsel patient about positive and negative results, and how to avoid the allergen(s). Schedule additional testing as needed.
Click here for a more detailed guide (Acrobat PDF viewer required)
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Diagnostic patch test reaction charts:
- Positive reactions are graded weak (+), strong (++), or extreme (+++). These reactions indicate sensitization, but are not absolute proof. Their predictive value is strengthened by patient symptoms and clinical history, but can vary by allergen and test conditions.
Click here for diagnostic positive reaction chart (Acrobat PDF viewer required)
- Negative reactions (-) are common, and are defined as no reaction to an allergen, and no history or symptoms suggesting that contact allergy. Remember to counsel patients that negative reactions can still help diagnose their contact allergy or skin condition.
Click here for diagnostic negative reaction chart (Acrobat PDF viewer required)
- Doubtful reactions (?) are often faintly macular, with homogenous erythema and no infiltration. If there is no supporting symptoms or history, reactions are likely negative, but retesting may be needed.
Irritant reactions are usually charaterized by pustules and patchy erythema, with no infiltration.
Click here for information about doubtful and irritant reactions (Acrobat PDF viewer required)
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Information about patch test reimbursement:
In the United States, three major coding systems are used for health care reimbursement: American Medical Association's Current Procedural Terminology (CPT ), Healthcare Common Procedure Coding System (HCPCS), and International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM).
- According to U.S. Medicare guidelines, physicians should use CPT code 95044 (or 95052 for photo patch tests) once for each allergen tested. The CPT code 95044 does not include a professional service component.
- Use appropriate and current ICD-9-CM codes for a diagnosis of allergic contact dermatitis (e.g., 692.0 for detergent-based to 692.9 for an unspecified cause).
- The level of evaluation and management (E/M) service reported and billed for reimbursement should be based on current history, exam and decision-making criteria, and supported by the medical record.
Click here for more detailed information about patch test reimbursement (Acrobat PDF viewer required)
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