Pediatric Coding Alert

Question: I would like to know the correct codes for billing a PPD test provided in the office. Should I use 86580 with V74.1 and what should I bill for the PPD administration?

Answer: You are using the correct diagnosis code: V74.1 (Special screening examination for bacterial and spirochetal diseases; pulmonary tuberculosis). Since the test is an inoculation screening test, which detects antibodies and the presence of the disease, rather than a vaccination, the test includes administering the skin test and you should not code separately for the administration. The AMA Resource Based Relative Value System does not include costs for a reading. Many patients who do not show a response to the test may never return for a reading so this nurse administration cost is not included in the RVUs for 86580 (Skin test; tuberculosis, intradermal). If the patient does return for a reading, you may code 99211 for the nurse reading. If the test is positive, a physician will typically have a face-to-face visit with the patient (99212-99214, Office or other outpatient services ) discussing the diagnosis and further evaluation and treatment options.

Do not code separately for the Mantoux. Code 86580 includes the purified protein derivative (PPD).