I would like some feedback regarding billing a 99211 for a PPD check. If a patient comes in and have a 86580 with an evaluation and management services, we should then be able to bill a 99211 when the patient returns for a reading from the nurse 48 to 72 hours later.
Please review the folowing supporting documentation.
I think if the nurse does the PPD check and the doctor initials off on the results, then we should be okay to bill a 99211, if the doctor interprets the results, we would bill a regular office visit code instead of a minimal.
The key will be to make sure that the nurse is performing the service with direct supervision of a physician under his written order, the results are documented and the doctor signs off.
Has anyone billed this way and had any problems doing so?
Bulletin Number: xxxxxx
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.
Bulletin Number: xxxxxx
CPT 2009 Manual, Professional Edition, Appendix C, page 497:
Example of 99211:
â€śOffice visit for 42 year old, established patient, to read tuberculin test resultsâ€ť
Which code is used to report the administration of the purified protein derivative (PPD)? When the patient is seen for the interpretation, can this be reported as a nurse visit and would the nurse be required to obtain vital signs?
Code 86580 is used to report the administration of the intradermal (Mantoux) test for tuberculosis. It also includes the cost of the test itself. An E/M code may be reported when the test is interpreted. If the interpretation is performed and documented by a nurse or medical assistant (under the direct supervision of a physician), code 99211 (office or outpatient E/M service, minimal) would be reported. The nurse should document why the patient was seen, the date of the PPD administration, and results of the test. It is not a requirement that vital signs be taken because only medically necessary services need to be performed. The physician must cosign the documentation. If the physician interprets the test, the service is reported with the appropriate-level E/M code (99201â€“99215). Code V74.1 (special screening examination for pulmonary tuberculosis) is the appropriate diagnosis code to report when the test is administered and interpreted for screening purposes. If the test is administered to further evaluate an illness, use the diagnosis code for the illness or symptoms. If the test result is positive, report code 795.5 (nonspecific reaction to tuberculin skin test without active tuberculosis).
The following is a MLN article that addresses â€śdirect supervisionâ€ť requirements
â€śYou do not have to be physically present in the patientâ€™s treatment room while these services are provided, but you must provide direct supervision, that is, you must be present in the office suite to render assistance, if necessary.â€ť