How to Code Correctly for Tuberculosis Skin Test

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Q: Giving a tuberculosis (TB) test (Current Procedural Terminology code 86S80) 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 $3J>0. 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?

A: You are correct that code 86580 (skin test; tuberculosis, intradermal), is an inoculation screening test and not a vaccine. It detects antibodies and the presence of the disease, so the test includes the administration, for which you should not code separately.

When billing code 86580 on the date the test is administered, use diagnosis codeV74.1 (special screening examination for bacterial and spirochetal diseases; pulmonaryTB).The Centers for Medicare and Medicaid Services' physician fee schedule says the national payment amount for code 86580 is $7.83.

Because many patients who do not show a response to the test may never return for a reading, the American Medical Association Resource-Based Relative Value System does not include costs for a reading. If a patient returns, use code 99211 for the nurse's reading. Incident-to rules may apply for the 99211 services, so check with your payer.

If theTB 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 theTB 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 www. …