Pulmonology Coding Alert

Question: When a patient reports to the pulmonologist for a pulmonary tuberculosis (TB) skin test, can we report the injection separately with 90772? Missouri Subscriber Answer: No, you cannot report 90772 (Therapeutic, prophylactic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) on this claim, because the TB test is not a subcutaneous or intramuscular injection and the code for the TB skin test includes the injection service. On the claim, report the following: • 86580 (Skin test; tuberculosis, intradermal) for the test, with V74.1 (Special screening examination for bacterial and spirochetal diseases; pulmonary tuberculosis) linked to show the reason for the test. Exposure means another Dx: If you have had known exposure to an individual with TB, you may add V01.1 (Contact with or exposure to tuberculosis) to the claim. You may be tempted to use V03.2 (Need for prophylactic vaccination and inoculation against bacterial diseases; tuberculosis [BCG]) instead of V74.1 for this claim. But since the injection is for testing and not for a BCG inoculation, you should use V74.1. E/M follow-up possible: Code 86580 does not have a global period to cover follow-up care. So if the patient returns to the pulmonologist for further TB test evaluation (such as to discuss the positive test results), you can report the appropriate-level E/M for the service with 795.5 (Non-specific reaction to tuberculin skin test without active tuberculosis) appended.