Pediatric Coding Alert

Question: Should I bill CPT 99211 for tuberculosis (PPD) reading?

New Jersey Subscriber

Answer: You should report the initial purified protein derivative (PPD) tuberculosis test with 86580 (Skin test; tuberculosis, intradermal). Although the code includes the cost of test administration, it does not cover any follow-up care. Therefore, if the child returns to the office to have the nurse evaluate the test's results, you may report 99211 (Office or other outpatient visit for the evaluation and management of an established patient ... typically 5 minutes are spent performing or supervising these services). You should link both the procedure and the E/M to the same screening diagnosis V74.1 (Special screening examination for bacterial and spirochetal diseases; pulmonary tuberculosis).

Most plans will usually pay for the nurse visit with the screening diagnosis. If the payer denies 99211, you may appeal the claim or charge the patient. Remember that 99211 will trigger a copayment for the visit.