Q:

7/24/2013
I have 2 patients that I have diagnosed with food protein induced enterocolitis (1 to rice and 1 to soy). They are getting closer to the age for doing an oral challenge. I am setting it up in my near by hospital as a short stay admission with IV in place and giving doses of offending protein per protocol. However, my question is on how do I bill this procedure? The hospital will charge for the admission but do I charge time like a typical oral challenge or is it different? Also, is it acceptable to do the challenge in the office (not attached or near a hospital) with IV in place or is the hospital setting preferred?

A:

Thank you for your inquiry.

There is no axiomatic approach to the performance of an oral food challenge. The best answer is found in an excellent review of food protein-induced enterocolitis by Drs. Jarvinen and Nowak-Wegrzyn (1). A direct quote from this reference is:

"Protracted emesis and dehydration necessitate fluid resuscitation in approximately 50% of reactive challenges. FPIES OFC is considered a high-risk procedure and should be conducted in a setting with available intravenous access and rapid fluid resuscitation. Although an inpatient setting is preferable, an outpatient setting with resuscitation capabilities and access to a laboratory (for neutrophil counts and stool analysis) is sufficient."

As you can see, the preferred location is the inpatient setting, but outpatient challenges can be done depending on resuscitation capabilities and accessibility to a laboratory. Other factors such as location of the nearest hospital, experience of the physician, et cetera, are of course taken into consideration. In the final analysis, since the outpatient location is permissible if these requirements are met, the decision to do so remains in the hands of the physician performing the challenge.

Unfortunately, our website is not designed to answer economic or billing questions. This is best dealt with by the Joint Council of Allergy, Asthma, and Immunology. For your convenience, the contact information of the Joint Council is copied below.

E-mail JCAAI at: info@jcaai.org

JCAAI
50 North Brockway
3-3
Palatine, Illinois 60067

Website: www.jcaai.org

Thank you again for your inquiry and we hope this response is helpful to you.

The Journal of Allergy and Clinical Immunology: In Practice
Volume 1, Issue 4 , Pages 317-322.e4, July 2013
Food Protein-Induced Enterocolitis Syndrome (FPIES): Current Management Strategies and Review of the Literature
Kirsi M. Järvinen, MD, PhD
Anna Nowak-Wêgrzyn, M.D.

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology