Primary Care Coding Alert

Question: We bill an injection fee for immunizations. Can we include an injection fee for a TB test?

Illinois Subscriber

Answer: No, you should not report immunization administration (90465-+90474, Immunization Administration for Vaccines/Toxoids) for administering a TB test. The vaccine for TB is the Bacille Calmette-Guerin (BCG), which is different from the purified protein derivative (PPD) test.

You, however, can bill for an E/M service (99211, Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician ...) to read a TB test. In CPT's Appendix C one of 99211's clinical examples is "Office visit for a 42- year-old, established patient, to read tuberculin test results." PPD tests require the patient return to the office to have the results read, unlike  vaccination, which only requires the vaccine to be injected (deposited) in the recipient's body.

Why: TB or the PPD test is a diagnostic test, not an immunization, which is a preventive procedure. The PPD test is for establishing a diagnosis of tuberculosis, unlike vaccination, which is to induce immunity in a patient. The vaccine for TB is the Bacille Calmette-Guerin (BCG) and not the PPD test.