Pulmonology Coding Alert

Question: I'm not sure which diagnosis code to use with 86580 when billing for a PPD on a patient with no known exposure to tuberculosis. Is it a screening V code or something else?

Alaska Subscriber

Answer: Opt for 86580 (Skin test; tuberculosis, intradermal) when coding for an initial purified protein derivative (PPD) tuberculosis test. Most payers, including Medicare, reimburse 86580 with several diagnosis and symptom codes related to the respiratory system. For example, Medicare accepts 86580 with 795.5 (Nonspecific reaction to tuberculin skin test without active tuberculosis), when the patient had a positive reaction to the PPD; V01.1 (Contact with or exposure to communicable diseases; tuberculosis) when the patient has known exposure. In this case, report V74.1 (Special screening examination for bacterial and spirochetal diseases; pulmonary tuberculosis) with 86580 when screening for pulmonary tuberculosis.

Spin-off: If a patient is not symptomatic, the carrier will not pay for the PPD test. A simple screening service is not payable unless the patient has signed an ABN (advance beneficiary notice).