Primary Care Coding Alert

Question: The December 2003 Family Practice Coding Alert states that you shouldn't bill for an injection administration in addition to a tuberculosis (TB) skin test. Since you should report an oral polio and intranasal flu vaccine administration, why can't you bill for a TB skin test administration that a nurse gives intradermally with a syringe? Also, I believe the 80000 codes include the interpretation that you recommend reporting separately. Would you please clarify your reasoning?

Pennsylvania Subscriber

Answer: Because 86580 (Skin test; tuberculosis, intradermal) is not a vaccination, you shouldn't also report immunization administration (90471, Immunization administration [includes percutaneous, intradermal, subcutaneous, intramuscular and jet injections]; one vaccine [single or combination vaccine/toxoid]) for giving the test. In the TB skin test, the nurse injects a tuberculin purified protein derivative (PPD) concentration into the patient's arm to assess the disease's presence. She doesn't administer the TB disease, as she does with the oral polio and influenza vaccines that you mention.
 
For immunizations, you should assign the appropriate administration code based on the delivery method, as well as the vaccine product. When your nurse administers an oral polio vaccine, you should report 90473 (Immunization administration by intranasal or oral route; one vaccine [single or combination vaccine/toxoid]) for the immunization administration and 90712 (Poliovirus vaccine, [any type(s)] [OPV], live, for oral use) for the polio vaccine. For giving an intranasal flu vaccine, you should use 90473 (administration) and 90660 (Influenza virus vaccine, live, for intranasal use) (vaccine product).
 
Although billing for the TB test interpretation is controversial from a public-relations stand point, you may separately report a face-to-face patient encounter for reading the test results. "Payment for 86580 includes the administration of the test only," CMS staff stated in an e-mail to the American Academy of Family Physicians  clarifying the skin test code. When a provider reads the results during a separate face-to-face encounter with the patient, Medicare will pay for the test result's interpretation with 99211 (... typically, 5 minutes are spent performing or supervising these services). CMS' response is available at www.aafp.org/x16698.xml.
 
In addition, CPT's Appendix C offers an "office visit for a 42-year-old, established patient, to read tuberculin test results" as a 99211 example.