PPD and 99211 on followup visit

[Guest guest]

We've discussed this before, but I guess I'm all confused -- again.

Are the rest of you doing this?

Day of injection – charge 86580 – Note: not allowed to charge an “administration” code

Day of test read – charge 99211 for nurse visit

Somehow, I thought the read was included in the 86580 – but these articles suggest otherwise.

Is everyone coding as below?

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http://www.aafp.org/fpm/20030900/coding.html

Tuberculosis skin tests

Q PPD (tuberculosis) intradermal skin tests involve injecting the PPD serum at one visit and examining the site two to three days later to see if any swelling has developed. Do I need to submit the CPT code for the intradermal skin test (86580) on the day the PPD is administered and then interpret the PPD for "free" on a subsequent day as a bundled service; or can I submit 99211 for the interpretation of the PPD by a nurse?

A You can submit 99211 if a patient requires subsequent evaluation of a test and no other service is performed. Medicare will also pay for this limited service. Note that if a nurse or other nonphysician provider who is unable to bill for this service under his or her own Medicare provider number performs this service under the physician's provider number, the "incident-to" requirements must be met. [For more information on Medicare's incident-to requirements, see "The Ins and Outs of 'Incident-To' Reimbursement," FPM, November/December 2001, page 23.]

http://www.aafp.org/fpm/20080100/coding.html

Diagnosis codes for PPD test

Q What is the correct ICD-9 code for the purified protein derivative (PPD) skin test, CPT code 86580?

A ICD-9 code V74.1 represents a special screening examination for pulmonary tuberculosis, including diagnostic skin testing for the disease. Often code V70.5, "Health examination of defined subpopulations," may be a secondary diagnosis to indicate the test is performed as part of a pre-employment or occupational health examination. Additional ICD-9 codes may be reported to indicate the patient's risk for tuberculosis. For example, report V01.1 for "Contact with or exposure to tuberculosis," 042 for HIV infection or 793.1 for "Nonspecific abnormal findings of radiological and other examination of the lung field."

Remember that when a patient returns for the PPD reading, even when the reading is done by a nurse working incident to your services, you may report code 99211 for this evaluation and management (E/M) service.

https://www.aafp.org/fpm/20070500/coding.html

86580 for tuberculosis testing

Q If I perform a purified protein derivative (PPD) test for tuberculosis, should I report code 90772, "Therapeutic, prophylactic or diagnostic injection (specify substance or drug); subcutaneous or intramuscular," in addition to code 86580, "Skin test; tuberculosis, intradermal"?

A No. Code 90772 does not accurately describe the procedure. You should report only code 86580, which includes the intradermal injection. If on a later date you examine the injection site for a reaction, then you may report an E/M code for the services rendered on that date. If a nursing staff member performs the exam of the injection site, it may be reported with code 99211. Incident-to rules may apply for 99211 services, so check with your payer.

Editor's note: While this department attempts to provide accurate information and useful advice, third-party payers may not accept the coding and documentation recommended. You should refer to the current CPT and ICD-9 manuals and the Documentation Guidelines for Evaluation and Management Services for the most detailed and up-to-date information. ================================

Locke, MD