Stay On Top of Your TB Coding With This Helpful Guide
Identify the correct IGRA testing codes. Pulmonary tuberculosis (TB) is a form of TB that affects the pulmonary system. The disease spreads easily between patients and can cause severe effects on the body. While TB isn’t as common in the U.S. as it was decades ago, pulmonology coders should still remain aware of how to correctly code the condition and testing in case their offices see at-risk individuals. Read on to refresh your TB knowledge. Recognize Tuberculosis Disease TB is caused by a bacterium called Mycobacterium tuberculosis. TB can develop in several places throughout the body and the symptoms that patients experience depend on the location of the TB germs. Pulmonary TB symptoms can include: Patients with a pulmonary TB infection may also experience weight loss, loss of appetite, chills, fever, night sweats, and weakness or fatigue. Patients who have TB infection can have active or inactive TB disease. Active TB is when the patient is exhibiting symptoms of the disease, like the ones listed above, whereas an inactive TB infection means that the patient does not have symptoms of the disease. If the patient is not treated for TB, then the disease can reactivate and make the patient sick. Build Your Diagnostic TB Test Code Knowledge Pulmonologists perform a blood test or a skin test to evaluate a patient for TB. The blood test, also known as interferon gamma release assay (IGRA), measures the blood’s immune response to TB antigens. Two blood tests are available commercially in the U.S. — the QuantiFERON®-TB Gold Plus (QFT-Plus) test and the T-SPOT®.TB (T-Spot) test. You’ll use the following codes for each test: Report 86480 when the provider performs the QFT-Plus test and use 86481 to report the T-Spot test. Assign 86580 (Skin test; tuberculosis, intradermal) to report a skin test for tuberculosis. The TB skin test is also known as a Mantoux tuberculin skin test (TST). The Centers for Disease Control and Prevention (CDC) “recommend[s] the TB skin test as the method of testing for children younger than 5 years of age, while noting that some experts use TB blood tests in younger children.” Code a TB Diagnosis As stated above, TB can affect different body structures depending on where the TB germs develop. Patients suffering from pulmonary TB will experience symptoms in the structures of the respiratory system, including the lungs, lymph nodes, and bronchus. Following a positive test result with confirmation by culture or histology, the physician can document the TB diagnosis. When the pulmonologist makes a definitive diagnosis of pulmonary TB, you’ll open the ICD-10-CM Alphabetic Index and locate Tuberculosis > pulmonary, which directs you to A15.0 (Tuberculosis of lung). Verify the code in the Tabular List. Under the A15.- (Respiratory tuberculosis) code category in the Tabular List, you’ll also find the following codes: Codes A15.0 through A15.5 each feature multiple conditions that can be reported with each code, depending on the documented diagnosis. For example, you’ll assign A15.0 for TB of the lung, TB bronchiectasis, TB fibrosis of the lung, TB pneumonia, and TB pneumothorax. Use A15.8 to report diagnoses of mediastinal TB, nasopharyngeal TB, TB of the nose, and TB of any nasal sinus. Primary respiratory tuberculosis, reported with A15.7, develops in patients who have not been previously exposed to the Mycobacterium tuberculosis bacterium. This condition most commonly occurs in infants and children. Code This Pulmonary TB Scenario Scenario: A new patient presents to a pulmonology office with orthopnea and right chest pain. The patient has experienced progressive dyspnea, night sweats, and a cough that has persisted for six weeks. The patient doesn’t have history of chronic heart failure, TB, or malignancy. They attested to recent travel. The pulmonologist performed a physical examination and documented decreased breath sounds and dullness to percussion at the right base, as well as mild respiratory distress. The provider ordered and reviewed two-view chest X-rays, which were captured in-house. After the X-rays, the pulmonologist performed a bedside ultrasound (US) that confirmed free-flowing pleural fluid, and then the physician performed a US-guided thoracentesis to collect fluid for testing. The pulmonologist also collected a sputum sample for testing. After receiving results from the lab, the physician diagnosed the patient with pulmonary TB and TB pleurisy. For this scenario, you’ll assign A15.0 and A15.6 as your diagnosis codes. The pulmonologist’s documentation shows the two diagnoses that are confirmed by the laboratory cultures. You’ll then turn to the CPT® code set to assign the appropriate procedure codes. Use 99205 (Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.) to report the new patient visit. The compromise of the patient’s respiratory function can support the high level of medical decision making (MDM). You’ll also need to assign modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to 99205 to show the evaluation and management (E/M) service is significant and separate from the thoracentesis. Assign 32555 (Thoracentesis, needle or catheter, aspiration of the pleural space; with imaging guidance) to report the US-guided thoracentesis procedure. Lastly, you’ll use 71046 (Radiologic examination, chest; 2 views) to report the two-view chest X-rays. Mike Shaughnessy, BA, CPC, Production Editor, AAPC
