How do we bill for placing the skin test for tuberculosis?
To bill for placing the purified protein derivative (PPD) skin test for tuberculosis, use CPT® code 86580. Use this code when the nurse or medical assistant places the test on the patient’s skin.
The CPT® definition of the code is: Skin test, tuberculosis, intradermal.
If that is the only service performed on that day, then only bill 85680.
- Do not report an injection code 96372 for placing the skin test.
- Do not report a nurse visit for the PPD injection.
- And don’t report 90471 for vaccine administration.
Code 86580 isn’t administering a vaccine, it is a skin test to determine of a person has TB.
If a preventive medicine service or problem oriented visit is done on the same day:
If a preventive medicine service or problem oriented visit is done on the same day as the PPD placement, bill for the E/M service and the PPD placement. Modifier 25 shouldn’t be required on the E/M, since 86580 is a diagnostic test. But watch claims payment to be sure the payer’s edit system doesn’t require a modifier.
When the patient returns to have the nurse read the test:
When the patient returns to have the nurse read the test, to see if it is positive or negative, then bill 99211. This is typically done in 48-72 hours. Remember that for Medicare, nurse visits must meet the criteria of incident to billing, so a physician or NPP must be in the office to bill Medicare for that service.
Related ICD-10-CM codes:
Z11.1 Encounter for screening for respiratory tuberculosis
Z20.1 Contact with and (suspected) exposure to tuberculosis