Wiki Billing 96372 with 86580

[wilsontheresa@optonline.net]

The practice I am billing for wants me to include the injection admin code with the CPT 86580. I am using modifier 25 on the E/M code but what other modifier must be appended to 96372, 59?

 

[Lisa Bledsoe]

96372 cannot be reported with 86580. Administration is inclusive.

 

[wilsontheresa@optonline.net]

Thanks for the response. Still confused though because Code it Right online suggests that it can be billed together with the use of modifier 59. The billing software I am using also indicates that they can be billed together if a modifier is used. I am just not sure which modifier is appropriate to use in this situation.

 

[mitchellde]

You cannot use 96372 to administer a test this code is for the administration of therapeutic or prophylactic medication. 86580 is a test for TB. You can add a 59 if you did two separate things so if all you did was administer a TB test then that is all you may bill for.. the 86580

 

[kumeena]

why you need modifier 25 with E/M. Usually ppd implant was done by nurse.I don't think this is a seperate procedure

 

[Lisa Bledsoe]

Thanks for the response. Still confused though because Code it Right online suggests that it can be billed together with the use of modifier 59. The billing software I am using also indicates that they can be billed together if a modifier is used. I am just not sure which modifier is appropriate to use in this situation.

Those codes are separately billable at the same encounter, but it would need to be a distinct procedural service (mod -59), as in if the patient also received an actual injection (ie B12). Reporting 96372 for placement of the PPD is inappropriate.

 

[mjs1974]

What about 90471? Can you bill that with 86580?

 

[MarcusM]

from the AAPC Coder on CPT 86580:
Question 3: I'm not sure whether to use an E/M code or 86580 for tuberculosis skin tests. Can I report the injection separately?
Answer: The physician would typically perform an initial purified protein derivative (PPD) for tuberculosis skin screening. You should report this with 86580 and link V74.1 or V01.1 (Contact with or exposure to tuberculosis) with it.
Don't fall into the trap of coding 99211 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.

 

[kbarron]

Is this a CLIA waived test?

 

[kramsey78]

Is it appropriate to bill 99211-25 with the 86580, if the patient is seeing a nurse only for the initial ppd placement?

 

[philipwells]

25 modifier is not necessary on the E&M when only labs are performed

 

[lgardner]

Is it appropriate to bill 99211-25 with the 86580, if the patient is seeing a nurse only for the initial ppd placement?

you cannot bill a 99211 with the placement of a ppd.

 

[kramsey78]

you cannot bill a 99211 with the placement of a ppd.

Thank you for your reply. Please advise what your rationale is behind your answer. Also, what are your credentials?

 

[mitchellde]

You cannot bill a 99211 with the PPD placement when that is the reason for the encounter. There is no assessment that is over above and beyond the PPD. Therefore it is not appropriate to bill a visit as significant and separate.