Primary Care Coding Alert

Question: Is anyone billing an office visit (99211) with the PPD (TB test) code (86580)?

Idaho Subscriber

Answer: As there is no actual E/M done during administration of PPD, you shouldn't bill for this. When administering the PPD test, you use these codes:

• V74.1 -- Special screening examination for bacterial and spirochetal diseases; pulmonary tuberculosis

• 86580 -- Skin test; tuberculosis, intradermal.

PPD testing results are read 48-72 hours after administering the skin test. This will require another office visit and evaluation of the results to determine whether it is negative or positive. Because a patient may not return for the reading, 86850's relative value units do not include the work of reading the test, according to Medicare.

Therefore, when a nurse does the reading, some offices choose to report the service using this E/M code:

• 99211 -- Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician. Usually, the presenting problem(s) are minimal. Typically, five minutes are spent performing or supervising these services.

In addition, if the results are positive, you use the following codes:

• 795.5 -- Nonspecific reaction to tuberculin test without active tuberculosis.

If it is negative, then continue using V74.1.