Testing for Tuberculosis (TB)
The specific amount you’ll owe may depend on several things, like:
Z11. 1: “encounter for screening for respiratory tuberculosis now includes “encounter for screening for active tuberculosis disease.”
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.
An induration of less than 5 millimeters (mm) is considered a negative test result. If you have symptoms or you know you've been exposed to someone with TB, you may be advised to get another test later.
Read ruler line on the inside right edge of the induration (use lower measurement if between two gradations on mm scale)....ReadingDo not record as “positive” or “negative”.Only record measurement in millimetres.If no induration, record as 0 mm.
For a purified protein derivative (PPD) check, bill with code 86580 Skin test; tuberculosis, intradermal. You wouldn't bill for an evaluation and management (E/M) because it takes about 1 second to run your hand over an arm to feel if there is induration.
Medicare does pay for CPT code 86580 when the patient has had exposure to TB or has had a reaction to a recent TB screening test.
A “positive” TB blood test result means you probably have TB germs in your body. Most people with a positive TB blood test have latent TB infection. To be sure, your doctor will examine you and do a chest x-ray. You may need other tests to see if you have latent TB infection or active TB disease.
The skin test should be read between 48 and 72 hours after administration. A patient who does not return within 72 hours will probably need to be rescheduled for another skin test.
The two-step tuberculin skin test (TST) is used to detect individuals with past tuberculosis (TB) infection who now have diminished skin test reactivity. This procedure will reduce the likelihood that a boosted reaction is later interpreted as a new infection.
The Mantoux tuberculin skin test (TST) or the TB blood test can be used to test for M. tuberculosis infection. Additional tests are required to confirm TB disease. The Mantoux tuberculin skin test is performed by injecting a small amount of fluid called tuberculin into the skin in the lower part of the arm.
The latest interpretation for Mantoux test resultsBaseline test: ≥10 mm is positive (either first or second step); 0 to 9 mm is negative.Serial testing without known exposure: Increase of ≥10 mm is positive.Known exposure: ≥5 mm is positive in patients with baseline of 0 mm.
In summary, 2-step PPD testing requires 2 PPD's to be placed, 1-3 weeks apart, with each of those tests read 48-72 hours after placement.
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.
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.
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.
The pertinent history is part of the HPI and will always include past TB history. It is very important to know if the patient has ever been diagnosed with active TB disease or TB infection before. Document dates of diagnosis or testing, location where the diagnosis or testing took place and what treatment was offered or completed. Document whether this patient was named as a contact to another TB case. Was he/she a contact to a known drug resistant case?
All TB patients will have a review of systems. It will be very limited for TB screening including only constitutional, skin, and respiratory. For those patients starting or being monitored on treatment, it will be much more in-depth.