Tuberculosis Test Requires Special Handling

As tuberculosis becomes more prevalent; it’s showing up more often as a coding dilemma. One of the most common questions is if the PPD test should be charged separately and the answer is yes-sometimes. The reason is that when a skin test such as the one for tuberculosis is done, if the results are negative the test will be considered inconclusive for diagnosis; however if the results of the PPD test are positive, then you are opening the door for further visits from a physician and treatment for a condition.

If you have no way of knowing the outcome of the test when you are compiling the medical billing, the best ICD-9 code to choose is 86580 (Skin test; tuberculosis, intradermal) for the test. The rest of how you code it will depend on the situation, if you are still awaiting results or you have results from the test. Additionally, if the reading is positive, a higher level visit is generally necessary and there will usually be additional services rendered such as patient review, full physical exam, lab work, chest x-rays and in some cases, counseling of the patient.

Another code that is usually reasonable to report with the PPD test is 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician.); To ensure proper reimbursement, a good rule of thumb is to check the individual payer’s guidelines to see what the criteria for filing this type of claim is to insure the best reimbursements for your services.

View all Articles by: Melissa Clark, CCS-P