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How to code correctly for tuberculosis skin test

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This month's questions ask about coding for tuberculosis skin tests and noncoverage notice updates. Find out the answers to these pressing coding questions.

Q: Giving a tuberculosis (TB) test (Current Procedural Terminology code 86580) involves a nurse drawing it up, administering it, examining the arm, and providing documentation to the patient about the result (usually a note that the TB test was negative). I am unsure how to code for this. The reimbursement for the actual medication is around $3.50. It is not a vaccine, so I can't charge a vaccine administration code. Using code 99211 is not always an option. It just seems like so much effort for so little reimbursement. Am I missing something?

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When billing code 86580 on the date the test is administered, use diagnosis code V74.1 (special screening examination for bacterial and spirochetal diseases; pulmonary TB). The Centers for Medicare and Medicaid Services' physician fee schedule says the national payment amount for code 86580 is $7.83.

If the TB test is positive, then typically you will have a face-to-face visit with the patient to discuss the diagnosis, further evaluation, and treatment options. Use code 99212-99214 (office or other outpatient services).

Do not code separately for the TB skin test because code 86580 includes the purified protein derivative.

KNOW YOUR NONCOVERAGE NOTICE UPDATES

Q: Would you explain the updates made to the advance beneficiary notice of noncoverage (ABN) instructions?

A: The voluntary issuance of an ABN is an option when a service is statutorily excluded from Medicare coverage or as a courtesy to forewarn a patient of his or her financial obligation.

June 1, the Centers for Medicare and Medicaid Services (CMS) updated its manual instructions and included a "Quick Glance Guide" to ensure you and your staff comply with the ABN issuance requirements (see MLN Matters Number MM7821, ABN Form CMS-R-131, at http://www.cme.hhs.gov/Regulations-and-Guidance/Guidiance/Transmittals/Dowloads/R2480CP.pdf).

The author is a medical consultant based in Indianapolis, Indiana.


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