Pediatric Coding Alert

Question: We are trying to link the purified protein derivative (PPD) tuberculosis test to the correct ICD-9 code. We have been using V03.2 , but we think that diagnosis is incorrect because V03.2 is a vaccination code. Which ICD-9 code should we report?


Texas Subscriber

Answer: You should instead use V74.1 (Special screening examination for bacterial and spirochetal diseases; pulmonary tuberculosis) with 86580 (Skin test; tuberculosis, intradermal). When a nurse or other individual administers a PPD TB test, she gives the child an inoculation screening test, not a vaccination.

The TB screening test detects the disease's presence by inoculating the skin with the TB antigen. It doesn't vaccinate the child. A vaccination uses an inoculation to confer disease immunity. Therefore, you should link the test code to the special screening V code instead of to the vaccination code.

In fact, you will probably never use V03.2 (Need for prophylactic vaccination and inoculation against bacterial diseases; tuberculosis [BCG]). The World Health Organization doesn't recommend that United States physicians administer the BCG vaccine. The inoculation isn't very effective and interferes with skin test screening. People who receive a TB vaccination can give a false-positive when screened for the disease.