Primary Care Coding Alert

Question: We charge for a PPD placement but historically have not coded for reading the test result. Can we report the reading separately, or is it included in the first visit when the nurse places the PPD? Virginia Subscriber Answer: Start by coding 86580 (Skin test; tuberculosis, intradermal) for the test. The answer to whether you code for the reading depends on the situation--- and on whom you ask. Some coders say the PPD reading is inclusive, which means you should not code it separately from the initial test. Other coders say a negative PPD reading is inclusive, but a positive PPD reading is worth coding separately if the physician devises a care plan for the positive test. Reasoning: A positive reading usually results in a formal office visit because of the additional work involved by the physician (patient history, patient examination, laboratory studies, chest x-ray, patient education and potential treatments). If your physician initiates additional plan of care following a positive PPD test (which may involve a chest x-ray and/or prophylactic treatment), it's reasonable to report the appropriate E/M code based on the specifics of the encounter. If you have doubts about how to code this scenario, check with your carrier.