TB Skin Test Coding

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In the provider office I work for, we perform TB skin tests. There is a debate going on whether or not 86580 is an appropriate code to bill out. In the past, they were told to bill out 90471, but a TB skin test is not a vaccine. We administer and read the TB skin test. Would coding this as 86580 (Z11.1) be appropriate?
 

Chelle-Lynn

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86580 is the correct code for billing the TB Skin Test otherwise known as the PPD. 90471 would be incorrect as this for a vaccine administration only. Z11.1 for Encounter for Screening for Respiratory TB would also be correct if the patient is there for a screening.
 
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Does 86580 include administering and reading the skin test? Also, what if the PPDs are given to the provider's office at no cost due to us being a non-profit organization? Could we still bill for administering them? Or being that they are given to us, are we unable to bill administering them?
 

Chelle-Lynn

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86580 is inclusive of the administration or placement of the PPD material. The reading of the PPD is not inclusive in the 86580. Depending on the office they may or may not charge for the reading of the PPD test. If they do charge for the reading the most common code is 99211 as the reading is normally completed by the providers staff. Possibly a higher E&M may be warranted if there is a reaction or positive read and additional evaluation and management is documented.
 
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Is it okay to bill out these services if the PPD material is given to us at no charge? Sorry for so many questions, but you have been the greatest help in getting answers for this. I can't even find a decent article that involves these codes, to show my manager. I can show a CPT book all day long, but if it is put into English for providers and managers to understand, then it helps out a lot
 

Chelle-Lynn

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Did you received the material through a special program (such as the 340B program, etc) that would restrict you from billing for the test? If not, then it would be ok to bill for the 86580 as this is inclusive of the material and the injection.
 
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One more question, who specifically can read a TB skin test? Again, I apologize for so many questions, but your help has been greatly appreciated. And now I can feel more at ease with how to bill these out appropriately
 

Chelle-Lynn

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It can vary by state. You may want to check with your local Public Health Department to make sure you are following your areas guidelines.
 
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