Question: I would like to know the correct codes for billing a PPD test provided in the office. Should I use 86580 with V74.1 and what should I bill for the PPD administration?
Answer: You are using the correct diagnosis code: V74.1 (Special screening examination for bacterial and spirochetal diseases; pulmonary tuberculosis). Since the test is 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 AMA Resource Based Relative Value System does not include costs for a reading. Many patients who do not show a response to the test may never return for a reading so this nurse administration cost is not included in the RVUs for 86580 (Skin test; tuberculosis, intradermal). If the patient does return for a reading, you may code 99211 for the nurse reading. If the test is positive, a physician will typically have a face-to-face visit with the patient (99212-99214, Office or other outpatient services ) discussing the diagnosis and further evaluation and treatment options.
Do not code separately for the Mantoux. Code 86580 includes the purified protein derivative (PPD).
Charge all allowed services with advice from Pediatric Coding Alert, by Jen Godreau, BA, CPC, CPMA, CPEDC.