Pediatric Coding Alert

Not billing CPT 99211 for PPD readings? You could be losing $21 per visit If you're questioning whether to bill a nurse visit when you interpret a tuberculosis test result, you're not alone. Faced with numerous endorsements that you can report a nurse visit for interpreting PPD test results, pediatricians who question this billing method's legitimacy may lose $22 per visit for no good reason. (Fees are based on unadjusted Medicare National Physician Fee Schedule for 99211: 0.57 relative value units x $37.34 conversion factor = $21.28.)

Wary MDs: Normally, physicians are the first to fight for every earned penny. Therefore, to hear them argue otherwise is an interesting development. "But physicians' reservations about reporting a 99211 for a TB interpretation are twofold," says Kent Moore, manager of Health Care Financing and Delivery Systems for the American Academy of Family Physicians in Leawood, Kan. CMS Clarifies That 86580 Covers Test Only The first concern comes from misconceptions regarding what the TB skin test fees include. "Many physicians have always understood or interpreted the TB skin test code to include the reading, so the idea of separately coding for that reading seems 'unnatural,'" Moore says. 86580 stands alone: This misunderstanding is now a thing of the past. "Payment for 86580 (Skin test; tuberculosis, intradermal) includes the administration of the test only," CMS staff stated in an e-mail to Moore clarifying the skin test code. When a provider sees a patient in a separate face-to-face encounter to discuss the results, Medicare will pay for the test result interpretation with 99211 (Office or other outpatient visit for an established patient ... typically, 5 minutes are spent performing or supervising these services), according to CMS. Interpretation Is Not Automatic You can separately bill 99211 because not all patients return to have the test results read. Although the patient is supposed to return to have the test area checked, not all patients actually do (especially those who see no skin changes). CMS'e-mail concurs with this nonautomatic interpretation visit, stating, "Reading of the test results ... is generally performed two-three days following the intradermal test in the office." The agency recognizes that the healthcare provider doesn't always perform the reading. The reasons for not returning to the office vary. For instance, the patient may not return because his spouse is a nurse, the patient knows what a negative or positive result looks like, or he may simply forget about the visit. Because the reading is not automatic, CMS does not include the interpretation in the test fee, so you can separately bill for it. Next, you will have to consider whether you want to charge for this service. Think About PR Despite [...]