Primary Care Coding Alert

Question: Do we include modifier 25 when a TB test is administered during an office visit? And can we charge a fee when the patient returns to have the TB test read?

Wyoming Subscriber

Answer: Yes, you may append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) when the physician completes an E/M service during the same encounter as administering a TB test. Append modifier 25 to the appropriate E/M code and also report 86580 (Skin test; tuberculosis, intradermal). Technically, you should not need to append modifier 25 to the E/M in this situation, since unlike many other services in CPT®, lab services are generally not understood to include an evaluation and management component from which the E/M service needs to be distinguished via modifier 25. However, if in doubt, there is no harm in appending modifier 25 to the E/M code in this situation.

When the patient returns for the test reading, some practices bill 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician ...). Other practices skip the billing unless the test is positive. In that case, they will charge for an E/M office visit associated with diagnosis 795.5x (Nonspecific reaction to test for tuberculosis ...) since the physician must evaluate the patient for treatment.