Primary Care Coding Alert

Question: What is the proper way to bill for TB skin testing? Is it appropriate to report 99211 when the patient returns for the reading of the TB test? Or should we only submit the charge for the TB test and consider the subsequent reading as bundled into the initial service? Also, what is the ICD-9 code for history of positive PPD (purified protein derivative of tuberculin) test?

North Carolina Subscriber

Answer: The initial TB test is reported with 86580 (Skin test; tuberculosis, intradermal) or 86585 ( tuberculosis, tine test). This code includes the cost of test administration but does not cover any follow-up care. Therefore, it is appropriate to report 99211 (Office or other outpatient visit) if the patient returned to the office to have the nurse evaluate the results of the test.

The ICD-9 code that reflects positive results from a current PPD test is 795.5 (Nonspecific reaction to tuberculin skin test without active tuberculosis). No specific code exists to describe personal history of a positive result. However, if a patient says that he has had a positive result in the past, you could retest him and use 795.5. Other options include V12.01 (Personal history of tuberculosis) or V71.2 (Observation for suspected tuberculosis).

Alternatively, you can simply perform a chest x-ray to check for TB. In this case, you would be assuming that he has the disease and you could report the x-ray with 011.91 (Pulmonary tuberculosis, unspecified, bacteriological or histological examination not done). The latter three diagnoses are not ideal, however, because no one wants to be labeled as having TB. It might be wiser to redo the PPD.