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Family Practice Coding Alert

You Be the Coder:
TB Skin Tests

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.
Question: When patients have a Mantoux test, is it appropriate to report both that code and a vaccine administration code?

Nebraska Subscriber

Answer: No, it would not be appropriate to report both, i.e., 86580, skin test; tuberculosis, intradermal; and 90471, immunization administration (includes percutaneous, intradermal, subcutaneous, intramuscular and jet injections and/or intranasal or oral administration); one vaccine (single or combination vaccine/toxoid). You should report 86580. Code 90471 is used only when a vaccine or toxoid is administered. Since 86580 represents a skin test to check for a reaction to tuberculosis antibodies and not a vaccination, 90471 would not apply.
 
Note: In an unusual midyear move, CPT has implemented two new codes (90473, immunization administration by intranasal or oral route; one vaccine [single or combination vaccine toxoid] and 90474, each additional vaccine [single or combination vaccine toxoid] [list separately in addition to code for primary procedure]) to describe the administration of oral or intranasal vaccines. Providing greater specificity for reporting purposes, these new codes became effective July 1, 2001, and follow the same guidelines as 90471 and 90472, which were simultaneously revised to remove references to intranasal and oral administration. Some payers may not be able to accommodate the new codes immediately, so coders should check with payers prior to submitting either of  these new codes.