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Z79.60 vs Z79.899 vs Z11.1

L

lzabar

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Swampscott, MA
What code are your docs using when ordering a TB test for psoriasis patients on a biologic?
Recently had a Medicare patient hit with a $900 lab bill for TB testing as required before starting the injections.
Medicare declined claim stating does not cover preventative screenings.
 
Was Z11.1 your primary diagnosis? If the patient is not currently on the biologic then neither Z79.60 and Z79.899 would not be appropriate. I would report Z11.1 and your psoriasis dx secondary. Make sure your provider is speaking to the medical necessity of the TB test prior to the medication starting. Sounds like a good case to appeal.
 
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