Primary Care Coding Alert

Question:

North Dakota Subscriber

When a patient comes to your office for Mantoux administration (also known as a tuberculosis skin test), you'll report 86580 (Skin test; tuberculosis, intradermal). If an E/M service is provided in conjunction with the skin test administration, you may also report the appropriate E/M code, such as 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician. Usually, the presenting problem[s]are minimal. Typically, 5 minutes are spent performing or supervising these services.)

Many offices do not charge for the follow-up check three days later. However, it is permissible, from a CPT perspective to report this follow-up with 99211, if reading the tuberculin test is the primary purpose of the office visit. As noted in Appendix C of CPT, one of the clinical examples of 99211 is "Office visit for a 42-year-old, established patient, to read tuberculin test results."

Idea: The patient's co-pay might be higher than the allowed amount for 99211 ($19.71 for the national non-facility fee, based on the Medicare conversion factor of $33.9764). Because of this, some physician offices don't collect a co-pay up front, but let patients know their insurance might say they have one. If you collect a co-pay that is higher than the allowed charge, you'll be faced with over collecting from the patient.