I would like to know if anyone is billing 99211 for the office visit associated with the PPD reading in New York State and if Medicare is covering it for symptomatic patients. i.e. Patient presents with hempotysis, PPD performed, we bill 86580 with 786.3, two days later patient returns and sees nurse who reads ppd 99211 786.3 (results were negative).
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Tuberculosis Skin Tests
Q. PPD (tuberculosis) intradermal skin tests involve injecting the PPD serum at one visit and examining the site two to three days later to see if any swelling has developed. Do I need to submit the CPT code for the intradermal skin test (86580) on the day the PPD is administered and then interpret the PPD for "free" on a subsequent day as a bundled service; or can I submit 99211 for the interpretation of the PPD by a nurse?
A. You can submit 99211 if a patient requires subsequent evaluation of a test and no other service is performed. Medicare will also pay for this limited service. Note that if a nurse or other nonphysician provider who is unable to bill for this service under his or her own Medicare provider number performs this service under the physician's provider number, the "incident-to" requirements must be met. [For more information on Medicare's incident-to requirements, see "The Ins and Outs of 'Incident-To' Reimbursement," FPM, November/December 2001, page 23.]
Diagnosis codes for PPD test
Q What is the correct ICD-9 code for the purified protein derivative (PPD) skin test, CPT code 86580?
A ICD-9 code V74.1 represents a special screening examination for pulmonary tuberculosis, including diagnostic skin testing for the disease. Often code V70.5, "Health examination of defined subpopulations," may be a secondary diagnosis to indicate the test is performed as part of a pre-employment or occupational health examination. Additional ICD-9 codes may be reported to indicate the patient's risk for tuberculosis. For example, report V01.1 for "Contact with or exposure to tuberculosis," 042 for HIV infection or 793.1 for "Nonspecific abnormal findings of radiological and other examination of the lung field."
Remember that when a patient returns for the PPD reading, even when the reading is done by a nurse working incident to your services, you may report code 99211 for this evaluation and management (E/M) service.
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