Erica1217
Guest
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
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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 ???
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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."
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."
Hi Ericia,
) 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.