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86580 and 99211

  1. Smile 86580 and 99211
    Medical Coding Books
    Everyone seems to have different opinions on this. How do you bill for a PPD test? (Placing and the reading 48-72 hours later).

    Some say to bill the 99211 when the patient returns. Some say only bill the 99211 if the test is positive since that requires additional workup.

    What do ya'll think? Thanks in advance for your time!


  2. #2
    Louisville, KY
    It has always been my understanding that reading of the PPD is inherent to the provision. Therefore, I wouldn't append any 99211 for follow ups. Maybe someone else has a slightly varied opinion, but I'd be cautious about creating additional charges for a service inherent to the initial.

  3. Smile
    That is my understanding as well but I have one MD who doesn't agree at all.

    Thanks for the input!!!

  4. #4
    We do not bill any service when the patient comes back to get the reading if it is neg. If however, the PPD is positive then depending on the documentation a 99211 might be justifiable since at this visit evaluation and management of a problem is occuring.
    Michelle Wood, RHIT, CCS-P, CPC, CPMA, CEMC, AAPC Fellow
    2018 AAPC Columbus, Ohio Chapter Treasurer

  5. #5
    Default PPD follow up
    Look at the AAPC EdgeBlast # 78 posted 6/6/07. It states that "code 86580 dos not cover any follow-up care so if the patient returns to the office to have the nurse evaluate the test results, you may then report 99211, assuming the visit meets the requirements of 99211."
    Christina Lee Wagner, CPC, CPC-H

  6. Default 86580
    Do you bill the 86580 (TB test) on the day of the service performed *OR* on the day the reading is done by the nurse?

  7. #7
    Overland Park, KS
    CPT Assistant, July 2006, states that if the reading of the PPD test is the primary purpose of the office visit, 99211 may be reported.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow

  8. #8
    North Carolina
    Quote Originally Posted by Bonita Gasser View Post
    Do you bill the 86580 (TB test) on the day of the service performed *OR* on the day the reading is done by the nurse?
    The day the test is performed. You need to capture the service/supply that was provided.
    Rebecca CPC, CPMA, CEMC

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