Internal Medicine Coding Alert
READER QUESTION ~ Charge for PPD Readings in Certain Situations
Question: We charge for a PPD placement but historically have not coded for reading the test result. Can we report the reading separately, or is it included in the first visit when the nurse places the PPD? Answers to You Be the Coder and Reader Questions were reviewed by Kathy Pride, CPC, CCS-P, director of government program services for QuadraMed in Reston, Va.; and Bruce Rappoport, MD, CPC, a board-certified internist who works with physicians on compliance, documentation, coding and quality issues for Rachlin, Cohen & Holtz LLP, a Fort Lauderdale, Fla.-based accounting firm with healthcare expertise.
Virginia Subscriber
Answer: Start by coding 86580 (Skin test; tuberculosis, intradermal) for the test.
The answer to whether you code for the reading depends on the situation -- and on whom you ask. Some coders say the PPD reading is inclusive, which means you should not code it separately from the initial test.
Other coders say a negative PPD reading is inclusive, but a positive PPD reading is worth coding separately.
Their reasoning: A positive reading usually results in a formal office visit because of the additional work involved by the provider (patient history, examination, laboratory studies, chest x-ray, patient education and potential treatments). If your physician initiates the workup following a positive PPD test, it's reasonable to report the appropriate E/M code based on the encounter's specifics. If you have doubts about how to code this scenario, check with your carrier.
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Question: We charge for a PPD placement but historically have not coded for reading the [...]
