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Pulmonology Coding Alert

Reader Questions:

Double-Check Documentation for 795.5 Claim

Published on Mon Jul 10, 2006

Question: We had a patient with a positive Mantoux (PPD) test and a negative chest x-ray. He presented to initiate INH (isonicotinic acid hydrazide) therapy. What diagnosis code should we report?

Washington Subscriber Answer: Code 795.5 (Nonspecific reaction to tuberculin skin test without active tuberculosis) is probably the most appropriate diagnosis code for the scenario you describe.
 
Caution: Even though the diagnosis is "without active tuberculosis," reporting 795.5 would get in the medical record database, which all insurers have access to, and some future carrier may interpret this code as tuberculosis and restrict any tuberculosis-related coverage. Health insurance obtained through employers would not have any such restrictions, however. But you should not be afraid to use the 795.5 diagnosis when you know it's the right code.
 
Bonus: As a secondary diagnosis code, you could also use V71.2 (Observation and evaluation for suspected conditions not found; observation for suspected tuberculosis).
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