According 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 PPDCPT Code 86580 Skin test; tuberculosis, intradermalICD-10 code Z11.1 Encounter for screening for respiratory tuberculosisNote: 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 TestIf 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 LTBIThe 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.
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