Primary Care Coding Alert

Question: We are trying to link the purified protein derivative (PPD) tuberculosis (TB) test to the correct ICD-9 code. We have been using V03.2, but we think that diagnosis is incorrect because V03.2 is a vaccination code. Which ICD-9 code should we report?

Texas Subscriber

Answer: You should instead use V74.1 (Special screening examination for bacterial and spirochetal diseases; pulmonary tuberculosis) with 86580 (Skin test; tuberculosis, intradermal). When a nurse or other individual administers a PPD TB test, she gives an inoculation screening test, not a vaccination.

The TB screen test detects the disease's presence by inoculating the skin with the TB antigen. It doesn't vaccinate the person, which is defined as using an inoculation to confer disease immunity. Therefore, you should link the test code to the special screening V code instead of to the vaccination code.

In fact, you will probably never use V03.2 (Need for prophylactic vaccination and inoculation against bacterial diseases; tuberculosis [BCG]). The World Health Organization doesn't recommend that United States physicians administer the BCG vaccine. The inoculation isn't very effective and interferes with skin test screening. People who receive a TB vaccination can give a false-positive when screened for the disease.