How To Use CPT Code 86580

CPT 86580 is a code used for tuberculosis skin testing; this article will cover its description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples.

1. What is CPT 86580?

CPT 86580 is a code used by medical professionals to bill for the administration and interpretation of a tuberculosis (TB) skin test, also known as the Mantoux test or purified protein derivative (PPD) test. This test is performed to determine if a patient has been exposed to the bacteria that cause tuberculosis.

2. 86580 CPT code description

The official description of CPT code 86580 is: “Skin test; tuberculosis, intradermal.”

3. Procedure

1. The lab analyst cleanses the test site on the patient’s forearm with rubbing alcohol.
2. A standardized concentration of tuberculin purified protein derivative (PPD) is extracted.
3. The PPD is injected under the top layer of skin in the forearm, causing a small welt to form.
4. The welt usually disappears within a few hours.
5. The patient returns to the office within 48 to 72 hours for the provider to read the results.
6. The provider records any reaction and discusses further steps with the patient as necessary.

4. Qualifying circumstances

Patients who are eligible to receive CPT code 86580 services include those who may have been exposed to tuberculosis, those who require the test for work or personal reasons, and those who are at a higher risk for developing TB, such as healthcare workers, immigrants from countries with high TB rates, and individuals with weakened immune systems.

5. When to use CPT code 86580

It is appropriate to bill the 86580 CPT code when a healthcare provider administers and interprets a tuberculosis skin test for a patient who meets the qualifying circumstances mentioned above. The code should not be used for other types of skin tests or allergy tests.

6. Documentation requirements

To support a claim for CPT 86580, the following information should be documented:

• Patient’s medical history and risk factors for tuberculosis
• Reason for the test (e.g., exposure, work requirement, etc.)
• Details of the test administration, including the PPD concentration used and the injection site
• Provider’s interpretation of the test results and any necessary follow-up actions

7. Billing guidelines

When billing for CPT code 86580, keep in mind the following guidelines:

• Do not report an E/M code for the actual screening, as no E/M service takes place during the administration of a PPD test.
• If the provider performs an E/M service in conjunction with the tuberculosis skin test administration, an appropriate E/M code, such as 99211, can be reported along with 86580.
• For the follow-up visit to evaluate the test results, the provider may choose to report the service using an E/M code, such as 99211.
• Do not report injection codes with 86580, as the TB skin test includes administration.
• Do not report modifier 51 with pathology and laboratory procedure codes; instead, use modifier 26 when the physician reports their service separately from the technical component.

8. Historical information

CPT 86580 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Similar codes to CPT 86580

Five similar codes to CPT 86580 and how they differ are:

• CPT 86480: This code is used for tuberculosis tests that measure gamma interferon antigen response, rather than intradermal skin tests.
• CPT 95012 – 95199: These codes are used for various skin tests for allergies, not tuberculosis.
• CPT 86015: This code is used for smooth muscle antibody testing, not tuberculosis skin testing.
• CPT code for Sporothrix antibodies: This code is used for testing antibodies to Sporothrix, a type of fungus, rather than tuberculosis.

10. Examples

1. A healthcare worker who may have been exposed to a patient with active tuberculosis receives a PPD test (CPT 86580).
2. An immigrant from a country with a high TB prevalence undergoes a PPD test as part of their immigration medical examination (CPT 86580).
3. A patient with HIV, who is at a higher risk for developing TB, receives a PPD test as part of their routine care (CPT 86580).
4. A college student living in a dormitory, where TB exposure is more likely, undergoes a PPD test (CPT 86580).
5. A patient who has been in close contact with someone diagnosed with active TB receives a PPD test (CPT 86580).
6. A healthcare provider administers a PPD test to a patient who works in a correctional facility, where TB exposure is more common (CPT 86580).
7. A patient with a history of intravenous drug use, which increases the risk of TB, receives a PPD test (CPT 86580).
8. A patient who has recently traveled to a country with a high TB prevalence undergoes a PPD test upon their return (CPT 86580).
9. A healthcare provider administers a PPD test to a patient who is starting a job that requires a negative TB test (CPT 86580).
10. A patient with a weakened immune system due to an organ transplant receives a PPD test as part of their ongoing care (CPT 86580).