PPD Reads

Erica1217

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Chicopee, MA
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Hi,

I answered a question regarding PPD reads; I'm copying it below and would like to hear what you all think...do you agree or disagree w/ what I said? I would also like to know if you are billing for these and, if so, are you getting reimbursed? Do you have to appeal because of the V-code? Do you get pt complaints? Any type of feedback will be much appreciated!

Thanks!
=) Erica

`````````````````````````
Hi,

PPD reads don't need to be a "no charge".

According to the CPT Assistant articles (see below), it is appropriate to charge for a 99211 for the PPD read.

I understand the concern is that the patient may complain about getting 2 co-pays or additional co-insurance for this; However, I don't think most insurances charge co-pays for "labs" (86580 for PPD Placement). My feeling is one co-pay can be collected and applied to the PPD read visit. IF the insurance does apply a co-pay or co-insurance to both services, then the patient should take it up with their insurance company.

Additionally, I would like to point out that the PPD placement, code 86580, only reimburses approximately $9.00 (according to our Medicare carrier's fee schedule - may be more or less for other payors).

If we don't charge for the PPD reading, then we are "giving away" 2 nurse visits and the cost of the drug itself for only $9.00.

I would think the amount of time and supplies our staff spends on a pt who comes in for a PPD placement & read is worth more than $9.00 ???

----------------------------------------------------------------
CPT ASSISTANT:

"July 2006 -
Question: If a patient presents for interpretation of the results of a PPD (purified protein derivative of tuberculin) test, what would be the appropriate code to report for this service?
AMA Comment: This service is considered part of the medical decision making component of a level of an evaluation and management (E/M) service. Therefore, as this would be included in the E/M service, no additional code would be reported for the reading of a PPD test. Further-more, if reading the tuberculin test is the primary purpose of the office visit, it would be appropriate to report code 99211.

July 1998 - Question: If a patient presents for interpretation (purified protein derivative of tuberculin) of the results of a PPD test, is there a CPT code that I can report for this service?

AMA Comment: This service is considered part of the medical decision making component of a level of Evaluation and Management service. Therefore, as this would be included in the E/M service, no additional code would be reported for the reading of a PPD test."
 

rthames052006

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Local Chapter Officer
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York, Pa
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Hi,

I answered a question regarding PPD reads; I'm copying it below and would like to hear what you all think...do you agree or disagree w/ what I said? I would also like to know if you are billing for these and, if so, are you getting reimbursed? Do you have to appeal because of the V-code? Do you get pt complaints? Any type of feedback will be much appreciated!

Thanks!
=) Erica

`````````````````````````
Hi,

PPD reads don't need to be a "no charge".

According to the CPT Assistant articles (see below), it is appropriate to charge for a 99211 for the PPD read.

I understand the concern is that the patient may complain about getting 2 co-pays or additional co-insurance for this; However, I don't think most insurances charge co-pays for "labs" (86580 for PPD Placement). My feeling is one co-pay can be collected and applied to the PPD read visit. IF the insurance does apply a co-pay or co-insurance to both services, then the patient should take it up with their insurance company.

Additionally, I would like to point out that the PPD placement, code 86580, only reimburses approximately $9.00 (according to our Medicare carrier's fee schedule - may be more or less for other payors).

If we don't charge for the PPD reading, then we are "giving away" 2 nurse visits and the cost of the drug itself for only $9.00.

I would think the amount of time and supplies our staff spends on a pt who comes in for a PPD placement & read is worth more than $9.00 ???

----------------------------------------------------------------
CPT ASSISTANT:

"July 2006 -
Question: If a patient presents for interpretation of the results of a PPD (purified protein derivative of tuberculin) test, what would be the appropriate code to report for this service?
AMA Comment: This service is considered part of the medical decision making component of a level of an evaluation and management (E/M) service. Therefore, as this would be included in the E/M service, no additional code would be reported for the reading of a PPD test. Further-more, if reading the tuberculin test is the primary purpose of the office visit, it would be appropriate to report code 99211.

July 1998 - Question: If a patient presents for interpretation (purified protein derivative of tuberculin) of the results of a PPD test, is there a CPT code that I can report for this service?

AMA Comment: This service is considered part of the medical decision making component of a level of Evaluation and Management service. Therefore, as this would be included in the E/M service, no additional code would be reported for the reading of a PPD test."

Well I agree and disagree... if thats possible... in the office I work in now... we don't charge for the reading because the pt's complained enough about having to pay a copay, although they weren't charged/billed for a copay for the actual test...

My personal opinion is that we should charge for a reading (99211) at one point we did until the complaints came in from the pt's who have copays with their insurance.
 

Susan R

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PPD Coding

:) Hi Ericia,

Strictly from a coding perspective, I agree with charging the 99211 for the follow up office visit. That's all I have at this point, my coding perspective:eek:) I don't worry too much about the reimbursement because I figure if I've coded correctly, then I've got my strong foundation to appeal denials as needed.

There is an excellent article in the AAPC Coding Edge #78, June 2007, regarding PPD coding, which can be accessed by members on this website.

Have a super day. Susan
 

RebeccaWoodward*

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CPT actually has a clinical example of 99211- (Back of book)

"Office visit for a 42-year-old, established patient, to read tuberculin test results".
 
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