Pediatric Coding Alert

Question: We charge for a PPD placement but historically have not billed for reading the test result. Can we bill separately for the reading, or is it included in the first visit when the nurse places the PPD?

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 could require a visit from the physician and therefore leads to a higher-level visit and would be coded at a higher level, because of the additional work involved (review, full exam, labs, order chest x-ray, patient education about x-ray process and potential outcomes).
 
If your staff completes the workup following a positive PPD test, it's reasonable 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). If you have doubts, check your major payers' guidelines.