Wiki Application of PPD test w/office visit

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nbuck

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We gave a patient her PPD test, which she needed for work, but she also was seen for a sinus infection. We coded the E/M code with a modifier 25 and the PPD (86580) with the screening diagnosis (V74.1). Insurance isn't paying saying it's included in the allowance for another service/procedure. We don't have a problem getting these paid when a patient comes in for a PPD alone and we code a 99211 and the 86580. Any suggestions as to how I can get it paid?
 
You stated that she had the PPD for work. Does her employer pay for these? If not then you will likely have to collect from the patient as this service is usually not covered by insurances. Hope this helps.
 
Appeal with records

I would appeal with the medical records. Mention in the appeal letter that the E/M was for a completely unrelated purpose (sinus infection).

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
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