Let Expert Advice Guide Your 86580 Reporting
Why you may be incorrectly reporting 99211 for TB tests
Your office can submit surefire tuberculosis skin test claims if you know the correct CPT and ICD-9 codes to use, along with which codes you should avoid to prevent denials.
Know When 99211 Applies
Although some allergy coders believe you should use 99211 (Office or other outpatient visit for the evaluation and management of an established patient ... typically 5 minutes are spent performing or supervising these services) for an initial purified protein derivative (PPD) tuberculosis test, you should instead report 86580 (Skin test; tuberculosis, intradermal).
Remember 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.
Most private and government plans will usually pay for the nurse visit with the screening diagnosis. If the payer denies 99211, you may appeal the claim or charge the patient. You should collect a copayment for the 99211 services the allergist provides during the follow-up visit.
Don't Confuse Inoculation and Vaccination Codes
Allergy coders often have trouble linking the correct ICD-9 codes to the PPD tuberculosis (TB) test. Best solution: You should report V74.1 (Special screening examination for bacterial and spirochetal diseases; pulmonary tuberculosis) with 86580 for pulmonary tuberculosis, says Denae M. Merrill, CPC, coding specialist with NEM Pulmonary Associates in Saginaw, Mich.
Watch out: Make sure you don't list V03.2 (Need for prophylactic vaccination and inoculation against bacterial diseases; tuberculosis [BCG]) because V03.2 is a vaccination code, coding experts say. When a nurse or other appropriate medical staff administers a PPD TB test, he has given an inoculation - a screening test, not a vaccination.
What you need to know: Choose V74.1 based on the fact that the physician uses the TB screen test to detect the disease's presence by inoculating the skin with the TB antigen. The TB screen doesn't vaccinate the person. Instead, the screen is an inoculation to confer disease immunity. Therefore, you should link the test code to the special screening V code instead of to the vaccination code, Merrill says.
In fact, you will probably never use V03.2. The World Health Organization doesn't recommend that U.S. physicians administer the BCG vaccine. The inoculation isn't effective and interferes with skin test screening. People who receive a TB vaccination can give a false-positive when screened for the disease.
Why You Should Skip Injection Codes
Don't be tempted to report injection codes with 86580. For instance, you should not report an administration code, such as 90782 (Therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular), with 86580, says Lisa Center, CPC, quality coordinator with Freeman Health System in Joplin, Mo.
The reason: The TB skin test includes the injection administration, Center says.
Since the test an inoculation screening test , which detects antibodies and the presence of the disease, rather than a vaccination, the test includes administering the skin test and you should not code separately for the administration. The Resource Based Relative Value System does not include costs for a reading. Many patients who do not show a response to the teat may never return for a reading so this nurse administration cost is not included in the RVUs for 86580. If the patient does return for a reading, the test may be positive. In these cases, you may code 99211 for the nurse reading.