skin testing

Intradermal Test Documentation: What the Record Needs, and What Your Software Should Keep

2026-11-04 · 6 min read

By Pankaj Sabharwal · Co-founder, Medora

Intradermal Test Documentation: What the Record Needs, and What Your Software Should Keep

The short answer: an intradermal test record should let someone who

wasn't in the room rebuild the session. That means the date, the patient,

each allergen or drug and the concentration used, the control, the bleb

and the result for every site, any recent antihistamine, the follow-up plan,

and the name and signature of the person who did the test. Software for

intradermal test documentation should keep all of that in one record, beside

the visit note, and should never let an empty site pass as a negative.

Intradermal testing usually follows a negative prick test, and it is often

the step that decides a venom or drug work-up. It is also the part of the

skin-test day that is easiest to under-document. The sessions are smaller,

the concentrations change from site to site, and the result is often written

on a paper grid and typed into the chart later.

What the record should hold

The British Society for Allergy and Clinical Immunology's nurse-led standard

operating procedure for adult intradermal testing (v8, 2019) is one of the

few public documents that spells out the record line by line. It advises a

proforma that records:

the date of the test;
the patient's name, date of birth and record number;
the drug or venom concentrations used;
the initial bleb size and the final wheal size after 20 minutes, with a

photograph if a late result is expected, and the flare size;

any recent antihistamine, with the date and time of the last dose;
the name, designation and signature of the person performing the test.

Two more items from the same procedure belong on the sheet, not just in the

nurse's head:

The control. The procedure includes a saline control with every

session "to assist with interpretation of the test".

The double check. Drugs, dilutions and expiry dates "should be checked

by two staff". If two people checked, the record should say who.

Sites that were never placed

Every intradermal session has a list of planned sites. Some never get done:

the patient feels unwell, a prick result changes the plan, or a child has had

enough. The record has to show the difference between "placed, no reaction"

and "not placed". A blank cell does neither. Mark each site that wasn't done

as not tested, with the reason, before anyone signs.

Late results and the follow-up

The BSACI procedure adds a late check 48 to 72 hours after the test when a

delayed reaction is suspected from the history, with patients sending

photographs and a description from home. That second result belongs in the

same record as the first, with its own date, not in an email thread.

The plan the patient takes home

The same procedure ends with the conversation after the test: the results

are discussed with the patient by a trained clinician and, when it applies,

"avoidance advice and written information is given". For a drug or venom

work-up, that written plan is often the most important page of the visit.

It should match the record, and the doctor should sign it before it goes

home.

How the record supports the units you bill

In the US, intradermal tests with allergenic extracts are reported with

CPT 95024, sequential and incremental tests with 95027, and delayed-type

tests with 95028. The ACAAI's April 2026 summary of Medicare's medically

unlikely edits lists per-day limits of 40 units for 95024, 90 for 95027 and

30 for 95028. It notes that a payer may pay above the limit on appeal, and

that the practice must "provide adequate documentation to support the

medical necessity of correctly reported units".

That is where the record earns its keep. The unit count on the claim should

equal the number of sites placed on the sheet, and the sheet should show why

each one was medically necessary. Our skin-testing CPT guide

covers the codes and units in more detail.

What to ask of intradermal test documentation software

Whether it is a module in your EHR or a separate tool, run one real

session through it and check:

One sheet per session. Are prick and intradermal results for the

same visit kept together, with the controls first?

Concentration per site. Can each site carry its own allergen and

concentration, rather than one value for the whole row?

Not tested is a real value. Can a site be marked not tested, and does

the sheet refuse to sign while a site is still blank?

Photos with the chart. If the nurse takes a photo of the arm, is it

stored with the patient's chart, or on a personal phone?

The late result. Is there a place for the 48 to 72 hour result in the

same record?

Sign-off. Does the sheet show who performed the test and who signed

the results?

Beside the note. Does the visit note sit with the results, so nobody

types them twice?

The handout. Does the written plan for the patient come from the same

record, signed by the doctor?

For the wider prick-and-intradermal list, see the [skin test documentation

checklist](/skin-test-documentation-checklist-for-allergy-practices/?utm_source=blog&utm_campaign=seo).

Where Medora fits

Medora is an AI copilot built only for allergy and immunology practices,

and it is built together with a working allergy practice, Allergy

Affiliates in Bradenton, Florida.

Medora's skin-test sheet covers prick, intradermal and multi-test sessions

end to end: from the order and controls, to the nurse's iPhone photos, to

the allergist-signed results.

The nurse takes the photos on an iPhone in the Medora app, and they are

stored with the chart.

Before the allergist signs a skin-test sheet, every site has a value staff

charted or confirmed, or is marked Not tested. A blank is never saved as

"no reaction".

Medora Scribe drafts the allergy note in the same record, so the

skin-test results the nurses recorded sit beside the drafted note and

nobody types them twice.

Medora drafts patient instructions from the visit, and the doctor reviews

and signs them before the family takes them home.

Medora works with supported EMRs, and the clinician reviews, edits and

signs every note.

In a 60-day pilot at Allergy Affiliates, the time an allergist spends signing

off each skin-test visit dropped sharply

(the case study).

Frequently asked questions

What should an intradermal test record include?

The date, the patient, each allergen or drug and its concentration, the

saline control, the bleb and the result for every site, any recent

antihistamine with the time of the last dose, and the name and signature of

the person who performed the test. Sites that weren't placed should be

marked not tested.

Which CPT codes cover intradermal tests?

95024 for intradermal tests with allergenic extracts, 95027 for sequential

and incremental tests, and 95028 for delayed-type tests. Medicare's per-day

limits are 40, 90 and 30 units respectively (ACAAI, April 2026).

Should a delayed result go in the same record?

Yes. When a delayed reaction is suspected, the 48 to 72 hour result should

sit in the same record as the 20-minute result, with its own date.

Does Medora handle intradermal sessions?

Yes. Medora's skin-test sheet covers prick, intradermal and multi-test

sessions, from the order and controls to the allergist-signed results, in

the same record where Medora drafts the allergy note.

See it on your own sessions

*Sources: BSACI Nurses in Allergy Committee, "Standard Operating Procedure:

Adult Intradermal Testing" (K. Powrie, v8, 11.03.2019),

https://www.bsaci.org/wp-content/uploads/2019/12/AdultIDTSOPFINAL.pdf (read

2026-11-04); ACAAI, "How Many MUEs Can Be Billed in a Day?" (April 13, 2026),

https://college.acaai.org/how-many-mues-can-be-billed-in-a-day/ (read

2026-11-04). CPT® is a registered trademark of the American Medical

Association. This article is general information, not clinical or billing

advice.*