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March 25, 2023

Skin Test for Tuberculosis (PPD)

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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 86580.

  • Do not report an injection code 96372 for placing the skin test.
  • Do not report a nurse visit for the intradermal service.
  • 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

Last revised November 9, 2020 - Betsy Nicoletti
Tags: Code sets and reimbursement

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Our mission is to provide up-to-date, simplified, citation driven resources that empower our members to gain confidence and authority in their coding role.

In 1988, CodingIntel.com founder Betsy Nicoletti started a Medical Services Organization for a rural hospital, supporting physician practice. She has been a self-employed consultant since 1998. She estimates that in the last 20 years her audience members number over 28,400 at in person events and webinars. She has had 2,500 meetings with clinical providers and reviewed over 43,000 medical notes. She knows what questions need answers and developed this resource to answer those questions. For more about Betsy visit www.betsynicoletti.com.

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