Get Multiple Flu Tests Paid

Get Multiple Flu Tests Paid

Using 87804 x 2 might result in denial.

If you’re performing a test that detects the flu via immunoassay in the office, your provider might test for two strains of the virus.
Impact: When you file these claims properly, you’ll be paid for two flu tests rather than one. Read on for a bit of knowledge on making your claims for flu tests sail through on the first try.

Use 87804 Each Time You ID a Flu Test

When the provider performs flu tests via immunoassay, code the screening with 87804 Infectious agent antigen detection by immunoassay with direct optical observation; influenza, says Maggie M. Mac, CPC, CEMC, CHC, CMM, ICCE, president of Maggie Mac-Medical Practice Consulting in Clearwater, Fla.
CPT® 87804 represents “a testing platform that yields a typically qualitative result by producing a signal on the reaction chamber,” explains Melanie Witt, CPC, COBGC, MA, an independent coding consultant in Guadalupita, N.M.
If the test fits all the parameters put forth in its code descriptor, you should report 87804 for your provider’s flu test.

Use QW for Medicare Patients

Remember that 87804 is a Clinical Laboratory Improvement Amendments (CLIA) waived test, meaning you need to have CLIA certification to perform these flu tests. Further, you must append modifier QW CLIA-waived test to each 87804 entry on your claim to indicate your CLIA status. Modifier QW is only required for Medicare payers, but some private payers might also want you to use QW.

Use Modifier 59 to Separate Tests

Once you’ve determined that your provider performed an 87804 flu test, you’re ready to check if she tested for both strains A and B of the flu. When your provider performs this test in the office for both flu strains A and B, you’ll be able to report 87804 twice. For the claim to succeed, however, you’ll need help from a modifier to separate the flu testsIf the provider documents that the test provides two separate results — one for influenza virus A and one for B — it would be appropriate to report two units of code 87804, says Witt.
Mac advises coders to list 87804 on two lines with modifier 59 Distinct procedural service appended to the second unit of 87804. This is preferable to reporting the code twice on the same line, in her experience. Mac reports seeing claims with 87804 x 2 on one line, and the second flu test code was “completely ignored” by the payer. When you test for flu types A and B, “you get better responses with 87804-59 on the second line,” she says.

Chris Boucher, CPC
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Chris Boucher, CPC, has 10 years of experience writing various newsletters and other products for The Coding Institute. His blog covers several areas of coding and compliance, including CPT® coding, modifiers, HIPAA compliance, and ICD-10 coding.

8 Responses to “Get Multiple Flu Tests Paid”

  1. Michelle Buras says:

    Our test is a single swab that test for a and b on the same test strip. How is it possible to code for both?

  2. Cheryl Christine Roskam, CPC says:

    This seems a bit misleading, I don’t understand how one Binax A/B test (https://www.cliawaived.com/web/items/pdf/INV_416_022_BinaxNOW_Influenza_AB_Test~373file3.pdf) can be billed twice when it is done with one swab and one test sample applied to one test card giving either a negative or positive for influenza A and B. I know there are other tests which are separate for A and B and it makes more sense to bill twice in that scenario.

  3. Cheryl Christine Roskam, CPC says:

    As a follow-up to my previous message, I found this on the AAPC forum (https://www.aapc.com/discuss/threads/coding-rapid-flu-testing.22599/?view=date#post-333253):
    “Here’s what CPT assistant has to say:
    Differentiating rapid influenza test, A and B strains on one device
    CPT Assistant, December 2007 Page: 15 Category: Bonus Issue
    Pathology and Laboratory
    Question:
    Please clarify whether reporting code 87804 two times, once with modifier 59 (87804, 87804 59), would be appropriate for differentiating rapid influenza tests; those providing separate, distinct results for both strains A and B on one device.
    Answer:
    The detection of both influenza A and B strains may be part of two entirely separate procedures or may be included within the same test device because these two analyses are not uncommonly requested by the clinician together. If the assays provided two separate results (eg, a result for influenza A and a result for influenza B), two units of 87804 would be appropriate. Modifier 59, Distinct procedural service, may be used to indicate that the two results represent separate services, when two units of 87804 are submitted.
    CPT Assistant © Copyright 1990–2009 American Medical Association. All Rights Reserved”
    CPT Assistant seems to be saying that because there are two different results when A and/or B are positive, the test can be billed twice.
    Another quote from CPT Assistant:
    Excerpt from CPT Assistant…(5-09)
    “Whether to report one or two units of code 87804, Infectious agent antigen detection by immunoassay with direct optical observation; influenza, varies according to the type of rapid testing method used distinguishing influenza A from influenza B. The rapid detection of influenza virus types A and B may be part of two entirely separate procedures or may be included within the same test device. If the assays provide two separate results (ie, a result for influenza virus A and a result for influenza virus B), it would be appropriate to report two units of code 87804. When two units of code 87804 are submitted, modifier 59, Distinct Procedural Service, may be used to indicate that the two results represent separate services (codes 87804 and 87804-59).”
    Since there is only one negative result showing on the Binax Now when both A and B are negative, it seems to follow that we should only bill CPT 87804 once.

  4. Melissa Toomey says:

    So Medicare is still paying for the flu tests 87804 if we bill like this.:
    87804 QW
    87804 59 QW
    Is that correct?

  5. Bruce Pegg, CPC-A says:

    To add to the debate:
    The CPT guidelines for 87260-87999 say “When separate results are reported for different species or strain of organisms, each result should be coded separately. Use modifier 59 when separate results are reported for different species or strains that are described by the same code.”
    This is echoed by the CPT Assistant advice and the asterisk that appears at the bottom of the first page of the Binax test. It reads, “It is recommended provider bill 87804QW for influenza A and 87804QW for influenza B.” This is supplemented by the manufacturer’s reimbursement information, which notes that one test has a national limit amount of $16.76, but that amount is doubled when testing for both influenza A and B.
    I take both of these to mean that the article, and Melissa’s comments, are correct: if your provider tests for both strains of influenza, regardless of the results, you should bill 87804 QW for the first test and 87804 59 QW for the second.

  6. Vicki Campbell says:

    We use modifier 91 and make a note on the claim for each line: 87804 (testing for Flu Type A), 87804 91 (testing for Flu Type B). We haven’t had any problems.

  7. Ashima Rohilla says:

    That’s really a great information regarding to use of modifiers 59 & QW. Also to clarify that it will get paid only when documentation supports for 2 reports.

  8. Kim Ruge says:

    I just received a rejection from traditional Medicare B today in regards to billing for the two separate 87804 flu tests with QW on the first flu test code and 59 QW on the second 87804 flu test.
    Received a rejection stating on the second code Contractual Obligations Previously Paid. Payment for this claim/service may have been provided in a previous payment.
    Has anyone else had a issue with Traditional Medicare B not paying for the second flu rapid test?
    Thank you

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