Reporting Tuberculosis Diagnosis and TestingAccording to the World Health Organization (WHO), tuberculosis (TB) is second biggest infectious killer of adults worldwide. In the US, more robust control programs have reduced the number of TB cases, but recent reports indicate that the disease, though curable and totally preventable, still remains a threat. In March, Huffington Post reported on the rise in TB cases in 19 states, including New York, California, Florida and Texas, Connecticut, Tennessee and Colorado. Infectious disease specialists and pulmonologists can rely on medical coding outsourcing companies to report TB diagnosis and screening accurately.

An infectious disease that most often affects the lungs, TB is spread through the air when the person with the disease coughs and sneezes. TB can also affect other parts of the body such as the kidney, spine and brain. The Centers for Disease Control and Prevention (CDC) estimates that that up to 13 million people in the US have latent tuberculosis infection (LTBI), that is, TB bacteria are present within their body but are not infectious. Overall, without treatment, this can progress to an active TB infection as they grow weaker because of risk factors such as HIV, weakened immune systems, diabetes, smoking and intake of immune-suppressing medications.

TB Screening Recommendations and Guidelines

Given that TB is still around, physicians should test for latent TB in patients who are at risk for infection and who would benefit from treatment, as well as in patients who have signs and symptoms of the TB. The final recommendation statement on screening for latent tuberculosis infection (LTBI) released by the U.S. Preventive Services Task Force (USPSTF) in 2016 recommends screening among adults who are at increased risk of tuberculosis, but who do not have symptoms. The CDC, the American Thoracic Society, and the Infectious Diseases Society of America recommend that clinicians screen for LTBI only among high-risk populations and when treatment is feasible. According to the CDC, persons at risk for developing tuberculosis include those:

  • Who have an increased likelihood of exposure to persons with tuberculosis disease
  • With clinical conditions or other factors associated with an increased risk of progression from LTBI to tuberculosis disease.

ICD-10 Codes to Indicate Diagnosis of TB

ICD-10 codes in the category A15 – A19 are used indicate a confirmed diagnosis of TB for reimbursement purposes.

A15 – A19 Tuberculosis

Includes: infections due to Mycobacterium tuberculosis and Mycobacterium bovis

Excludes: congenital tuberculosis (P37.0)

pneumoconiosis associated with tuberculosis (J65)

sequelae of tuberculosis (B90.-)

silicotuberculosis (J65)

A15 Respiratory tuberculosis, bacteriologically and histologically confirmed

A15.0  Tuberculosis of lung, confirmed by sputum microscopy with or without culture

A15.2  Tuberculosis of lung, confirmed histologically

A15.3  Tuberculosis of lung, confirmed by unspecified means

A15.4  Tuberculosis of intrathoracic lymph nodes, confirmed bacteriologically and histologically

Excludes: specified as primary (A15.7)

A15.5  Tuberculosis of larynx, trachea and bronchus, confirmed bacteriologically and histologically

A15.6  Tuberculous pleurisy, confirmed bacteriologically and histologically

Excludes: in primary respiratory tuberculosis, confirmed bacteriologically and histologically (A15.7)

A15.7  Primary respiratory tuberculosis, confirmed bacteriologically and histologically

A15.8  Other respiratory tuberculosis, confirmed bacteriologically and histologically

A15.9  Respiratory tuberculosis unspecified, confirmed bacteriologically and histologically

A16 Respiratory tuberculosis, not confirmed bacteriologically or histologically

A16.0  Tuberculosis of lung, bacteriologically and histologically negative

A16.1  Tuberculosis of lung, bacteriological and histological examination not done

A16.2  Tuberculosis of lung, without mention of bacteriological or histological confirmation

A16.3  Tuberculosis of intrathoracic lymph nodes, without mention of bacteriological or histological confirmation

Excludes: when specified as primary

A16.4  Tuberculosis of larynx, trachea and bronchus, without mention of bacteriological or histological confirmation

A16.5  Tuberculous pleurisy, without mention of bacteriological or histological confirmation

Excludes: in primary respiratory tuberculosis

A16.7  Primary respiratory tuberculosis without mention of bacteriological or histological confirmation

A16.8  Other respiratory tuberculosis, without mention of bacteriological or histological confirmation

A16.9  Respiratory tuberculosis unspecified, without mention of bacteriological or histological confirmation

A17.9  Tuberculosis of nervous system, unspecified

A18   Tuberculosis of other organs

A18.0 Tuberculosis of bones and joints

A18.1  Tuberculosis of genitourinary system

A18.2  Tuberculous peripheral lymphadenopathy

Excludes: tuberculosis of lymph nodes:

A18.3  Tuberculosis of intestines, peritoneum and mesenteric glands

A18.4  Tuberculosis of skin and subcutaneous tissue

Excludes: lupus erythematosus

A18.5  Tuberculosis of eye

Excludes: lupus vulgaris of eyelid

A18.6  Tuberculosis of ear

Excludes: tuberculous mastoiditis

A18.7  Tuberculosis of adrenal glands

A18.8  Tuberculosis of other specified organs

A19     Miliary tuberculosis

A19.0  Acute miliary tuberculosis of a single specified site

A19.1  Acute miliary tuberculosis of multiple sites

A19.2  Acute miliary tuberculosis, unspecified

A19.8  Other miliary tuberculosis

A19.9  Miliary tuberculosis, unspecified

Reporting the Skin Tests for Tuberculosis

There are two screening methods available for LTBI:

  • the Mantoux tuberculin skin test (TST), and
  • Interferon-gamma release assays (IGRAs)

The CDC recommends screening with either these methods, but not both.

  • Tuberculosis Testing (Mantoux/Purified Protein Derivative (PPD)

    – Administration of PPD

    CPT Code 86580 Skin test; tuberculosis, intradermal

    ICD-10 code Z11.1 Encounter for screening for respiratory tuberculosis

    Note: Since the PPD test is a screening test, it includes administration of the test. A separate administration code should not be reported for this test.

    – Reading of PPD Test

    If patient returns to have a nurse read the test results, report the following codes:

    CPT code 99211 Office or other outpatient services (nurse visit or negative outcome)

    Z11.1 Encounter for screening for respiratory (nurse visit or negative outcome);

    CPT code 99212-99215 Office or outpatient services (physician services for positive encounter)

    R76.11 Nonspecific reaction to tuberculin skin tuberculosis (if test is positive)

  • Interferon-gamma release assays (IGRAs) for LTBI

    The two FDA approved IGRA testing methods are: QuantiFERON-TB Gold In-Tube (QFT-GIT) and T-SPOT.TB (T-Spot])

    CPT 86480 Tuberculosis test, cell medicated immunity antigen response measurement; gamma interferon (QuantiFERON-TB Gold In-Tube [QFT-GIT)

    CPT 86481 Tuberculosis test, cell mediated immunity antigen response measurement; enumeration of gamma interferon-producing T-cells in cell suspension (T-SPOT.TB [T-Spot])

    IGRAs require a single blood sample. The skin test reaction is measured in millimeters of the “induration” after 48 to 72 hours. These assays require laboratory processing within 8 to 30 hours after collection.

Other relevant CPT Codes

TB-specific tests

87555  Infectious agent detection by nucleic acid (DNA or RNA); Mycobacterium tuberculosis, direct probe technique

87556  Infectious agent detection by nucleic acid (DNA or RNA); Mycobacterium tuberculosis, amplified probe technique

87557  Infectious agent detection by nucleic acid (DNA or RNA); Mycobacterium tuberculosis, quantification

Nonspecific TB tests

71020  Radiologic examination, chest, 2 views, frontal and lateral

71260  Computed tomography, thorax; with contrast material(s)

87116  Culture, tubercle, or other acid-fast bacilli (e.g., TB, AFB, and mycobacteria) any source, with isolation and presumptive identification of isolates

87118  Culture, mycobacterial, definitive identification, each isolate

87143  Culture, typing; gas liquid chromatography (GLC) or high pressure liquid chromatography (HPLC)

As physicians intensify their efforts to put an end to the disease, medical billing and coding outsourcing is a practical option to ensure proper claim submission and reimbursement.