Pulmonology Coding Alert

Question: Does anyone bill for purified protein derivative (PPD) interpretation? If so, would you please explain the process?

Rhode Island Subscriber

Answer: PPD is a two-step process. The initial step requires the physician to place the intradermal PPD (purified protein derivative of tuberculin). You should report this service with 86580 (Skin test; tuberculosis, intradermal). 

The second step of the PPD involves the physician "reading" the test results within 48-72 hours after he places the intradermal PPD in the patient. If a nurse performs the "reading," you should report 99211 (Office or other outpatient visit for the E/M of an established patient ...).

If the physician completes the reading, you should report 99212 (Office or other outpatient visit for an established patient ...), as long as the physician meets all the requirements for this level of E/M coding (including problem-focused history or exam and straightforward decision-making). Also, the physician should document the details to justify this level of E/M service in the medical record. 

Warning: The physician does not need an exam room to complete the PPD reading. In some cases, the patient may think that the cost of an additional copay for this brief service is unnecessary, and he may be upset to pay the second copay.

In such an instance, you should explain the necessity of the reading, particularly in cases in which the test may be positive.

When the results are positive, the patient should have additional counseling and education. Patients are also more likely to understand the need for an additional copay when the physician provides a more extensive service.