With the exception of independent laboratory providers, portable X-ray providers, and pharmacy providers, providers should indicate a TB-related TB-Only Benefit — listed in the table below. Providers are reminded that this list is not exhaustive and intended to provide examples only. Providers should submit the most appropriate diagnosis code as supported in the medical record. Providers are responsible for keeping current with diagnosis code changes. Claims submitted that do not include a TB-related diagnosis code as the primary diagnosis may be denied. Providers may use additional ICD diagnosis codes in the secondary positions as appropriate.
This list is not an exhaustive list of allowable tuberculosis diagnosis codes. Other diagnosis codes representing tuberculosis may be appropriate for submission.
| Diagnosis Codes | Descriptions |
|---|---|
| A15.0 | Tuberculosis of lung |
| A18.4 | Tuberculosis of skin and subcutaneous tissue |
| A18.2 | Tuberculous peripheral lymphadenopathy |
| A18.03 | Tuberculosis of other bones |
| A18.01 | Tuberculosis of spine |
| A18.02 | Tuberculous arthritis of other joints |
| A15.6 | Tuberculous pleurisy |
| A18.11 | Tuberculosis of kidney and ureter |
| A18.84 | Tuberculosis of heart |
| A18.83 | Tuberculosis of digestive tract organs, not elsewhere classified |
| A17.81 | Tuberculoma of brain and spinal cord |
| A18.89 | Tuberculosis of other sites |
| R76.11 | Nonspecific reaction to tuberculin skin test without active tuberculosis |
| R76.12 | Nonspecific reaction to cell mediated immunity measurement of gamma interferon antigen response without active tuberculosis |
| Z20.1 | Contact with and (suspected) exposure to tuberculosis |
| Z03.89 | Encounter for observation for other suspected diseases and conditions ruled out |
| Z11.1 | Encounter for screening for respiratory tuberculosis |
Service-specific information about diagnosis codes is available for independent laboratory providers, portable X-ray providers, and pharmacy providers.