Pathology/Lab Coding Alert

Methods define 86480 and 86580

Testing for Mycobacterium tuberculosis (TB) infection has been around for a long time, but new and deleted codes in CPT Codes 2006 mean you’ll have new ways to report TB evaluation. Make sure you understand the methods and indications for TB tests if you want to get paid for these services.

New Code 86480 Reports Blood Test

CPT 2006 adds 86480 (Tuberculosis test, cell-mediated immunity measurement of gamma interferon antigen response) to describe an in-vitro blood test for TB. Deleted Category III code 0010T had the same definition, and 86480 represents a conversion of this method to Category I status.

The 86480 test measures the blood’s cell-mediated immune response--secretion of a cytokine called gamma interferon--to TB-specific proteins. The method for measuring the T-cell response is enzyme-linked immunosorbent assay (ELISA). 

Advantage: This blood test is useful for people who have had prior Bacillus Calmette Guerin (BCG) vaccination because the test measures immune response to two TB-specific proteins--ESAT-6 and CFP-10--that were never included in the BCG vaccine. These proteins are also absent from most non-tuberculous mycobacteria, thus avoiding false-positive results for exposure to other mycobacteria.

Skin-Test Coding Updated
 
In addition to adding the new code for the TB blood test, CPT 2006 also deletes a code for an old TB skin test: 86585 (Skin test; tuberculosis, tine test). That doesn’t mean the TB skin test is gone--just the tine test.

Old way: Called a “tine,” “button,” or “prong” test, physicians used to press a four-pronged tool laced with tuberculin antigen into the patient’s skin to invoke a potential antibody response. Coders described the test as 86585, but the test is rare now because it is not very accurate.

New way: The newer skin test also involves injecting tuberculin antigen to determine if the patient has an antibody response, but medical personnel now use a single needle for the intradermal injection. You should report administering this test as 86580 (Skin test; tuberculosis, intradermal). Although this code is not new, it is the only TB skin-test code that remains in CPT. Physician office labs are more likely to use this code. Look for: You might also see the test ordered as a Mantoux test or a PPD (purified protein derivative) test. Both of these names refer to 86580.

Pitfall: Don’t be tempted to report injection codes with 86580. For instance, you should not report an administration code, such as 90772 (Therapeutic, prophylactic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular), with 86580, says Lisa Center, CPC, quality coordinator with Freeman Health System in Joplin, Mo. The TB skin test includes the injection administration, Center says.

Opportunity: You may be able to report a separate code for reading the TB skin test, however. If the patient returns after the test administration for a practitioner to evaluate the injection site, you may be able to report 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician. Usually the presenting problem[s] are minimal. Typically, 5 minutes are spent performing or supervising these services).

The practitioner will perform an E/M service, including asking patients about “any reactions or non-reactions they may have had in the 24-hour period,” says Pat Larabee, a coding specialist with InterMed in South Portland, Maine. The practitioner will also examine the site and book the patient for follow up if the results are positive.

Key: Your documentation should clearly indicate that the practitioner performed an E/M service, including evaluating the test results and planning follow-up care for positive results, says Susan Pincus, CPC, CHC, an independent coding consultant in Atlanta.

Proper Diagnosis Ensures Payment

Physicians may order a TB skin test (86580) or blood test (86480) due to pulmonary TB symptoms or known TB exposure or risk. The ordering diagnosis should be V74.1 (Special screening examination for bacterial and spirochetal diseases, pulmonary tuberculosis), says Denae M. Merrill, CPC, coding specialist with NEM Pulmonary Associates in Saginaw, Mich.

Watch out: Make sure you don’t list V03.2 (Need for prophylactic vaccination and inoculation against bacterial diseases; tuberculosis [BCG]), because V03.2 is a vaccination code, not a test code.

If the preliminary 86580 test is positive, the physician should order additional testing using diagnosis code 795.5 (Nonspecific reaction to tuberculin skin test without active tuberculosis). This code simply means that the patient is PPD positive or reactive, or perhaps had an abnormal Mantoux test, not that the patient has TB.

Unfortunately, there is a slight chance that this could harm a patient’s future insurance with the tuberculosis label, Center says. The bottom line: You should not be afraid to use the 795.5 diagnosis. This is the right code for a positive PPD, and avoiding it would be fraudulent, Center says.