86580

Skin test; tuberculosis, intradermal

CPT code 86580 represents an intradermal skin test specifically designed to detect a delayed hypersensitivity immune response to Mycobacterium tuberculosis, the causative agent of tuberculosis (TB). Commonly referred to as the Mantoux tuberculin skin test (TST) or PPD (purified protein derivative) test, this procedure is a cornerstone in the screening and diagnostic workup for latent tuberculosis infection (LTBI) and active tuberculosis. The test involves the intradermal injection of exactly 0.1 mL of tuberculin purified protein derivative into the volar surface of the forearm. The injection must be performed precisely to create a pale wheal 6 to 10 millimeters in diameter. If the wheal is not formed, the test is invalid and must be repeated immediately at a site at least two inches away or on the opposite arm. Following the administration of the antigen, the patient is instructed to return to the clinical setting within 48 to 72 hours for an assessment of the injection site. A trained healthcare professional evaluates the site to measure the induration (the hard, raised, palpable area), rather than the erythema (redness). The diameter of the induration is measured transversely to the long axis of the forearm and recorded in millimeters. The interpretation of the test results relies strictly on the size of the induration, coupled with the patient's specific risk factors for TB infection, including their immune status, occupational exposure, recent contact with individuals having active TB, and radiographic findings. It is essential to note that CPT code 86580 encompasses only the administration of the tuberculin antigen and the cost of the material itself. It does not include the subsequent evaluation and interpretation of the skin test results, which must be reported separately using the appropriate evaluation and management (E/M) code (often 99211) or specific test reading codes if applicable under payer rules. This procedure is frequently indicated for healthcare workers upon employment, individuals residing or working in high-risk congregate settings, patients undergoing immunosuppressive therapies (such as TNF-alpha inhibitors), and immigrants from endemic regions. Thorough documentation is required to indicate the site of administration, the lot number and expiration date of the PPD serum, and the precise technique utilized.

Clinical Indications

  • Screening for latent tuberculosis infection (LTBI).
  • Evaluation of individuals with known or suspected exposure to active tuberculosis.
  • Pre-employment screening for healthcare workers and individuals working in high-risk congregate settings.
  • Screening prior to the initiation of immunosuppressive therapy (e.g., biologic agents like TNF-alpha inhibitors).
  • Routine screening for immigrants, refugees, or travelers from countries with a high incidence of tuberculosis.
  • Diagnostic workup of patients presenting with signs and symptoms of active tuberculosis.

Procedure Steps

  1. Verify the patient's identity and review their medical history for contraindications, such as a previous severe reaction to a tuberculin skin test.
  2. Select a site on the volar aspect of the forearm, avoiding areas with scars, tattoos, or excessive hair.
  3. Cleanse the selected site with an alcohol swab and allow it to air dry completely.
  4. Draw exactly 0.1 mL of tuberculin purified protein derivative (PPD) into a tuberculin syringe equipped with a 27-gauge needle.
  5. Insert the needle intradermally, with the bevel facing up, at an angle of 5 to 15 degrees.
  6. Inject the PPD slowly to produce a distinct, pale wheal measuring 6 to 10 mm in diameter.
  7. Withdraw the needle gently and apply light pressure with gauze if bleeding occurs; do not massage or bandage the site.
  8. Instruct the patient to keep the site uncovered, avoid scratching, and return to the clinic in 48 to 72 hours for the clinical reading.

Coding Guidelines

  • CPT code 86580 includes both the provision of the purified protein derivative (PPD) test material and the intradermal administration of the test.
  • Do not report an immunization administration code (e.g., 90471, 90472) in conjunction with 86580 for the administration of the TB skin test.
  • The reading of the test at 48-72 hours is not included in 86580. If an evaluation and management (E/M) service is provided at the time of the reading, report the appropriate E/M code (e.g., 99211) if documented properly.
  • If the test is invalid due to improper administration (no wheal formed) and the test is repeated on the same day, only one unit of 86580 should generally be reported, subject to specific payer policies.
  • Ensure a specific ICD-10 diagnosis code supporting the medical necessity of the test is linked on the claim form.

Associated ICD-10 Codes