Pediatric Coding Alert

Question: I've heard conflicting information on coding tuberculosis skin tests. Should we use an E/M code or CPT 86580 ? Can we report the injection separately?


Missouri Subscriber

Answer: If your pediatrician performs an initial purified protein derivative (PPD) tuberculosis test, you should report 86580 (Skin test; tuberculosis, intradermal). Link 86580 to a diagnosis of V74.1 (Special screening examination for bacterial and spirochetal diseases; pulmonary tuberculosis).

Some coders may recommend 99211 (Office or other outpatient visit for the evaluation and management of an established patient ...) for PPD, but this is incorrect unless the nurse performs a separately identifiable E/M service, in which case you can append modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) to 99211 and report it along with 86580. Note, however, that 86580 does not cover any follow-up care. Therefore, if the patient returns to the office so the nurse can evaluate the test's results, you may report 99211.

Don't be tempted to report injection codes with 86580. The TB skin test includes administration.