How should one bill for TB (Tuberculin) Testing?

6 Feb

Question to Healthcare Fraud Shield

I am reviewing a case in which the provider is billing CPT codes 90471, 85680, 99211 and diagnosis Code V03.2.  I have denied the 90471 as 86580 is not considered a vaccine, it is considered a lab.  My question is am I also able to deny the 99211 because the patient was only in the office for this TB test?

Dear Healthcare Fraud Shield Reader:

Thank you for your question! Healthcare Fraud Shield believes you are correct in your thinking. If the patient was only in for the TB test, it is not appropriate to bill a 99211. I copied and pasted below information found on AAPC Coder regarding this. Also, note that 99211 can be billed when the patient returns to have the test read.

“TIPS” from AAPC Coder:

“The provider may order 86580 as a TB skin test, TB delayed hypersensitivity testing DHT or DHR, Mantoux test, tuberculin skin test, or purified protein derivative test PPD.

No E/M service takes place when administering a PPD test, so don’t report an E M code for the actual screening. When administering the PPD test, use codes V74.1 Special screening examination for bacterial and spirochetal diseases; pulmonary tuberculosis along with 86580 or report V01.1, Contact with or exposure to tuberculosis, when the patient has known exposure to tuberculosis. However, you can report an appropriate EM code, such as 99211 along with 86580 if the provider performs an E/M service in conjunction with the tuberculosis skin test administration. PPD testing results are read 48 to 72 hours after administering the skin test. This will require another office visit and evaluation of the results to determine whether it is negative or positive. As 86580 does not cover any follow up care, when a provider does the reading, the provider may choose to report the service using an E M code. Therefore, if the patient returns to the office to have the provider evaluate the test’s results, you may then report 99211, Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician.”

Thanks again for your question and for reading Healthcare Fraud Shield’s newsletter.

2 Responses to “How should one bill for TB (Tuberculin) Testing?”

  1. Lin at 5:20 pm #

    I disagree. CPT for the PPD is 86580 which reads in relevant part: ” The test site is examined at 24, 48, and 72-hour intervals for evidence of induration. Evidence of a reaction is recorded. ” The recording of the reaction is therefore included in the fee for 86580. Unless there is some other reason to appear at the physician’s office recorded in the chart, I don’t think its billable.

  2. Thank you for your feedback. Healthcare Fraud Shield has confirmed the information provided was properly stated per AAPC Coder- Coding Tips and was quoted it correctly. We also found 2 more sources that agree that a visit can be billed for f/u readings.

    If you have additional feedback, please feel free to pass along.

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