How To Use CPT Code 86580

CPT 86580 refers to the intradermal skin test for tuberculosis, a crucial diagnostic procedure used to detect the presence of tuberculosis (TB) infection in patients. This test involves the administration of a purified protein derivative (PPD) intradermally, typically on the forearm, and is a key tool in public health for identifying individuals who may have been exposed to the TB bacterium, Mycobacterium tuberculosis. The results of this test are evaluated within 48 to 72 hours, allowing healthcare providers to determine the need for further diagnostic imaging or treatment.

1. What is CPT code 86580?

CPT code 86580 represents the procedure for conducting an intradermal skin test specifically for tuberculosis. This test is essential in the clinical setting for screening individuals who may have been exposed to TB, especially in high-risk populations or settings. The purpose of the test is to identify delayed hypersensitivity to the tuberculin protein, which indicates prior exposure to the TB bacterium. The test is performed by a qualified healthcare provider who administers the PPD solution under the skin, creating a localized reaction that can be measured after a specified period. The clinical relevance of this test is significant, as it aids in the early detection of TB, which is crucial for preventing the spread of this infectious disease.

2. Qualifying Circumstances

The use of CPT code 86580 is appropriate under specific circumstances. It is primarily utilized when a healthcare provider suspects a patient may have been exposed to tuberculosis or when screening is required for employment, travel, or other personal reasons. The test is indicated for individuals who are at higher risk for TB, such as those with a history of exposure, immunocompromised patients, or those living in areas with high TB prevalence. However, it is not appropriate for individuals who have had a previous positive TB test or those who are symptomatic of active TB, as further diagnostic procedures would be warranted in such cases. Additionally, it is important to note that no evaluation and management (E/M) service should be billed in conjunction with the administration of the PPD test unless a separate E/M service is performed during the same visit.

3. When To Use CPT 86580

CPT code 86580 is used when conducting the intradermal skin test for tuberculosis. The procedure involves the careful administration of the PPD solution, followed by a follow-up visit to read the results. It is essential to note that this code should not be reported alongside injection codes, as the administration of the test is included within the scope of 86580. If a patient returns for the reading of the test results, an appropriate E/M code, such as 99211, may be reported if the reading is the primary purpose of the visit. However, if the provider performs additional services during the visit, those should be documented and billed accordingly. It is also important to avoid using modifier 51 with this code, as it is not applicable to pathology and laboratory procedure codes.

4. Official Description of CPT 86580

Official Descriptor: Skin test; tuberculosis, intradermal.

5. Clinical Application

The clinical application of CPT code 86580 is vital in the detection and management of tuberculosis. The intradermal skin test is a straightforward yet effective method for screening individuals for TB infection. The test is particularly important in public health settings, where early identification of TB cases can help prevent outbreaks. Following the administration of the test, the healthcare provider must evaluate the reaction at the test site to determine if the result is positive or negative. A positive result typically necessitates further evaluation, including chest X-rays, to assess for active TB disease. The timely application of this test can significantly impact patient outcomes and public health efforts in controlling tuberculosis.

5.1 Provider Responsibilities

The provider’s responsibilities during the administration of the intradermal skin test include several key steps. First, the provider must cleanse the test site on the patient’s forearm with rubbing alcohol to prevent infection. Next, the provider extracts a standardized concentration of PPD and carefully injects it just beneath the top layer of skin, creating a small raised area or welt. After the injection, the provider must instruct the patient on the importance of returning for the reading of the test results within 48 to 72 hours. During the follow-up visit, the provider assesses the reaction at the injection site, records the findings, and discusses the implications of the results with the patient, including any necessary follow-up actions.

5.2 Unique Challenges

There are several unique challenges associated with the administration and interpretation of the intradermal skin test for tuberculosis. One challenge is ensuring that the patient returns for the reading of the test results, as failure to do so can lead to missed diagnoses. Additionally, the interpretation of the test results can be complex, as various factors, such as the patient’s history, risk factors, and the size of the induration, must be considered. Providers must also be aware of the potential for false-positive or false-negative results, which can occur due to prior vaccinations or other medical conditions. These complexities necessitate thorough training and experience for healthcare providers performing and interpreting the test.

5.3 Pre-Procedure Preparations

Before administering the intradermal skin test, the provider must conduct a thorough evaluation of the patient’s medical history and risk factors for tuberculosis. This may include assessing any previous TB tests, vaccinations, or symptoms suggestive of active TB. The provider should also ensure that the patient understands the procedure and its significance, as well as the importance of returning for the reading of the results. Proper documentation of the patient’s history and the informed consent process is also essential to ensure compliance with clinical guidelines.

5.4 Post-Procedure Considerations

After the administration of the intradermal skin test, the provider must schedule a follow-up appointment for reading the results. During this follow-up visit, the provider evaluates the injection site for any signs of induration or reaction, which indicates the presence of TB infection. The provider must document the findings accurately and discuss the implications with the patient, including any further diagnostic steps if the result is positive. It is also important for the provider to educate the patient about TB, its transmission, and the importance of treatment if necessary.

6. Relevant Terminology

Intradermal injection: An injection administered between the layers of skin, allowing for localized testing and reactions.

PPD: Abbreviation for purified protein derivative, a substance used in the TB skin test to check for tuberculosis infection.

Tuberculosis (TB): An infectious disease caused by the bacterium Mycobacterium tuberculosis, primarily affecting the lungs but can also impact other systems in the body.

7. Clinical Examples

1. A healthcare provider screens a new employee in a healthcare facility for tuberculosis exposure before starting work.

2. A patient with a history of close contact with a TB-infected individual undergoes a skin test to determine if they have contracted the disease.

3. An immunocompromised patient is tested for TB as part of their pre-operative evaluation to ensure safety during surgery.

4. A college student is required to provide proof of a negative TB test before enrolling in a nursing program.

5. A patient presents with respiratory symptoms and is tested for TB to rule out active infection.

6. A healthcare provider administers the PPD test to a patient who has traveled to a region with high TB prevalence.

7. A patient with a previous positive TB test is referred for a chest X-ray to evaluate for active disease.

8. A public health official conducts TB screening in a community with a known outbreak.

9. A patient returns to the clinic for the reading of their TB skin test results after 72 hours.

10. A provider discusses the implications of a positive TB skin test result with a patient and outlines the next steps for evaluation and treatment.