Primary Care Coding Alert

Faced with numerous endorsements that you can report a nurse visit for interpreting tuberculosis test results, family physicians (FPs) who question the legitimacy of this billing method may lose $20 per visit without reason. So, gather the facts and let your FP decide. Normally, physicians are the first to fight for every earned penny. Therefore, to hear them argue otherwise is an interesting occurrence. "But FPs' 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 Code 86580 Covers Test Only The first concern comes from misconceptions regarding what the fees for the tuberculosis skin test include. "Many FPs 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 explains. This misunderstanding is now, however, 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 have the results read, Medicare will pay for the interpretation of the test results 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 Separately billing 99211 is permissible because not all patients return to have the test results read. "Every patient is supposed to return to have the test area checked, but I doubt that all patients (especially those that see no skin changes) actually have it checked," says Susan O. Minchew, CPC, CHC, director of billing compliance for Emory Healthcare in Atlanta. CMS'e-mail concurs with this nonautomatic interpretation visit by stating, "Reading of the test results is generally performed 2-3 days following the intradermal test in the office." The agency recognizes that the reading is not always performed. Reasons for not returning to the office vary. For instance, the patient may not return because his or her spouse is a nurse, the patient knows what a negative or positive result looks like, or he or she may simply forget about the visit, Moore says.Because the reading is not automatic, the interpretation is not included in the test fee and is thus separately billable. Consequently, FPs will have to consider whether they want to charge for this service. PR Headaches Matter Despite these reasons, billing 99211 for the interpretation is still sticky due to patient relations (PR) concerns because the nurse code may trigger a copayment. "Fees usually range from $5-$30, [...]