Advocating for patch testing units
Ask the Expert
By Victoria Houghton, Managing Editor, February 1, 2022
DermWorld spoke to Cynthia Stewart, CPC, COC, CPMA, CPC-I, manager of coding and reimbursement resources for the American Academy of Dermatology Association (AADA), about the Academy’s successful efforts to advocate for increased patch testing units in Local Coverage Determination (LCD) policies.
DermWorld: The AADA recently learned of two Medicare Administrative Contractors (MAC) that were planning to reduce skin patch testing units for allergic and other contact dermatitis through proposed Local Coverage Determination (LCD) policies. How did the AADA hear about this issue?
Stewart: AADA staff takes a proactive approach to proposed LCD changes through weekly monitoring of each of the MACs’ proposed LCD notices. When proposed LCDs with potential impact to our members and patients are identified, the Academy Dermatologic Contractor Advisory Committee (DermCAC) members are engaged in identifying the impact and developing a response to the proposed changes. The AADA learned that Novitas Solutions and First Coast Service were planning to reduce the skin patch testing units for allergic contact dermatitis through their LCD policies when we were reviewing their proposed LCD notices.
DermWorld: What did the Academy do to advocate against these policies?
Stewart: We worked with the Dermatologic Medicare Contractor Advisory Committee to ensure that both MACs understood the dermatology patient’s perspective. We contacted the MACs and explained to them that ACD is a chronic debilitating disease that can significantly affect a patient’s quality of life. With incorrect or delayed diagnosis, many patients continue to suffer and undergo multiple specialist visits, using numerous inadequate therapies. The burden of disease and treatment failures can lead to significant patient distress, morbidity, and disability, and contribute greatly to increased health care expenditures.
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DermWorld: How did the AADA explain the value of the patch test in accurately diagnosing ACD?
Stewart: We emphasized that accurately diagnosing ACD through identification of the substance(s) causing the reaction on the skin is critical to properly treat ACD. The appropriate management of ACD is the performance of a comprehensive test of suspected allergens and to provide alternative products, barriers, and protection, or adjusting working conditions to avoid the specific agents responsible for the recurring problem. This means that if specific allergens are identified and appropriate strategies are implemented for allergen avoidance, there will be not only reduced medical costs from unnecessary physician visits and medications, but also enhanced quality of life.
DermWorld: The AADA not only advocated against the reduction of patch testing units, but it advocated for 80 patch testing units. Why?
Stewart: ACD is definitively diagnosed by proper application, reading, and clinical correlation of patch tested allergens. Studies have shown that medical history alone is inadequate to diagnose ACD in the majority of cases. Additional studies have also shown that when limited patch testing with a series of less than 80 panels is performed, only about one third of patients are fully evaluated.
DermWorld: What other arguments did the AADA bring to the table?
Stewart: We also argued that these proposed limitations were at variance with the CMS Medically Unlikely Edit for CPT 95044 which allows for 80 units. For these reasons and to ensure patient access to quality dermatologic care, we encouraged these MACs to increase the allowed number of units for patch testing to allergic contact dermatitis to, at the very least, the national MUE of 80 units.
And the AADA was successful! Both MACs revised their proposed LCDs and increased the number of patch testing units from 65 to 80.
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