Pulmonology Coding Alert

Question: Should I code an office visit with PPD (TB test)?

Answer: No. There is no actual E/M service done during a visit where the sole purpoae is the administration of PPD. Instead, you should report these:

• V74.1 -- Special screening examination for bacterial and spirochetal diseases; pulmonary tuberculosis
• 86580 -- Skin test; tuberculosis, intradermal.

Typically, PPD testing results are read 48-72 hours after administering the skin test. This means another office visit and evaluation of the results to determine whether it is negative or positive.

Quick fact: Because a patient may not return for the reading, 86850's relative value units do not include the work of reading the test, according to Medicare.

Therefore, when a nurse does the reading, you should bill these codes:

• 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, five minutes are spent performing or supervising these services
• 795.5 -- Nonspecific reaction to tuberculin test without active tuberculosis (if the results are positive)
• V74.1, if the results are negative.

Note: most offices choose not to charge an office visit for ppd readings since the patient may have to pay a copay.