Pulmonology Coding Alert

Question: I'm not sure whether to use an E/M code or 86580 for tuberculosis skin tests. Can I report the injection separately?

Michigan Subscriber

Answer: The physician would typically perform an initial purified protein derivative (PPD) for tuberculosis skin screening. You should report this with 86580 (Skin test; tuberculosis, intradermal), and link V74.1 (Special screening examination for bacterial and spirochetal diseases; pulmonary tuberculosis) or V01.1 (Contact with or exposure to tuberculosis) with it.

Don't fall into the trap of coding 99211 (Office or other outpatient visit for the evaluation and management of an established patient...) for PPD because this is incorrect. Note, however, that 86580 does not cover any follow-up care. Therefore, if the patient returns to the office to have the nurse evaluate the test's results, you may then report 99211 to some payers. Although some payers may permit billing a minimal E/M (e.g., 99211) for the reading, the patient will be required to pay a co-pay for this service.

You also shouldn't report injection codes with 86580. The TB skin test includes administration.