Home Forums Discussions Coding and Billing Coding PPDs

I had a patient want to come in today to get a PPD only, and also return on Friday for a read. I ended up charging a nurse visit only 99211 but did not charge for the PPD as they were cash pay. Do you charge again for the read?

If you charge a nurse visit, I don't think you get paid anything anyways for 99211. Correct me if I am wrong because I would love to get paid for the nurse reads.

I'm pretty sure it is a billable code.

AAFP 2004 FPM:
Reporting 99211 can bring additional revenue into your practice. Specific payment amounts will vary by payer, but the average unadjusted 2004 payment from Medicare for a 99211 service is $21. This means that only five 99211 encounters with Medicare patients in a week will result in over $5,000 per year for a practice. Although this may not sound like a lot of money, it is easy revenue. Most practices already provide a number of 99211 services but fail to capture those charges. Remember, all services have a cost associated with them, and practices need to recoup as much of these costs as is legitimately possible.

Wow, it does. I need to start billing them.
Do you charge a copay for nurse visits?
DO you still have to do vitals for a nurse visit only?

So, what are some of these? We're pretty good and charging for everything, but not perfect. We've always charged for the PPD read, though we had to figure out how at first.

A question for clarification:
Can I bill CPT 86580 for giving the tuberculosis skin test and then CPT 99211 when the nurse reads the test?

i believe so. we do, but we dont have a nurse so Dr C reads it. And we charge a copay for that second visit too.

Here was what we "Devined" from an old FPM article and discussion many years ago.... If you folks remember a dear old now MIA user and poster Dr Roy a great defender of Doctors, patients and data access... He and I and a few others (Leslie were you in on all of this too???) If memory serves me correctly:

1) First Visit is like a "Shot Visit" with two codes (numbers not coming to me and I'm at home telecommuting with Kids home) so One code for the actual "Subtance" vaccine and the 2nd code for the admin of a sub Cu injection... And use the DOS that the person first came in... First Claim....

2) Second Visit for the reading. Have the Doctor look at it and "Read" it. This makes it an honest level 2 and not a 1 because docs are never level 1, always a two no matter what... BUMP!!!! So on this DOS submit a second claim for the face to face encounter of reading it, charting it, perhaps even writing a note for an employer because many of these people actually need these PPD's for work as healthcare workers or school and pre-school teachers and the like, right? Really, the moment you start counseling, advising

And if there is ANYTHING other than a good clean "No Reaction" test that needs NO Explaining or advising, then we are starting to approach a very valid level 3 or 4 because TB is Nothing to Sneeze (cough???) at..... If you have to start advising, re-testing, interfacing with the health dept, and the like, then you are certainly in some serious need to be compensated for the hassle and time consumed on behalf of the patient like situation....

And if you really think about it, this makes the most honest valid coding of the situation too. What did you honestly do the that first visit???? You did a very real and valid shot visit and all that goes with it including purchasing, tracking lot #'ing, storing, a real serium and you consumed a needle and gloves and the like that needs to be disposed of via medical waste stream too.... And the electricity that keeps all of your vaccines and seriums safe and healthy.... Not so simple and not something to be belittled or poo-poo'ed...

And what did you honestly do on the second visit???? You as a doctor used your training, your skills and knowledge to properly read the outcome of a very subjective test, and you have to document it, it could one day come back on you as you are swearing to the State that this person whether as a student to be living in a dorm, a healthcare worker or a daycare providers is safe and sound to be interfacing with the general public.... And you are almost certainly providing "Someone" with proof of the outcome of this test documented on Letter Head or better yet on your own AC Generated (software and system to upkeep) State specific tamper resistant RX paper...

Suddenly you are not doing almost "Nothing" now are you???? So many people want to bargin us down and make us take CCHIT for what we do, when in reality, even a "Simple" Rx Refill is never NOTHING.... What if you are wrong, what if it is time for a F/U???

It is time to start making sure we get paid for all the all to valid work and decision making, charting, notetaking and professional opinions you good folks provide based on all too real and valid training and licensing... Otherwise, I say, send 'me down the road for "Charlie" at the Quick Lube to to do all of these things practically for free.... It's the same way my wife and I feel about the two extra G&Q codes for women's wellcare....

"Put her up on the Rack Charlie!!!!" Give me a break. Claim what is rightful yours and stop selling yourselves short.... Nobody else can read, document and "Certify" with an Offical Dx and letter, Rx that someone has had a good, clean and valid PPD and for very good reason... because you went to Med School to learn how to do it and the process is NOT without additional stuff involved including staff like me having to order supplies like the serium, needles, medical waste pick-ups, pay for all of the above and that staff members time and wages no less your time and training....

Paul