ED Coding and Reimbursement Alert

Question: We recently ran a rapid strep test on a young patient who came in complaining of a sore throat. The nurse who administered the test used R07.0 in the electronic health record (EHR). The test came back negative, and the doctor documented that the patient had a viral sore throat. How should we bill the strep test — with the R07.0 or with a J02.- code?

Hawaii Subscriber

Answer: Typically, you would report J02.9 (Acute pharyngitis, unspecified) to reflect the patient’s chief complaint of a sore throat in the absence of a more definitive diagnosis from administering a rapid strep test such as 87880 (Infectious agent antigen detection by immunoassay with direct optical observation; Streptococcus, group A).

Because the test came back negative for strep, you cannot report J02.0 (Streptococcal pharyngitis). If the physician identifies the infectious agent causing the viral pharyngitis, you may report J02.8 (Acute pharyngitis due to other specified organisms) in addition to a secondary code (B95-B97) to identify the infectious agent. If no infectious agent is documented, but the physician definitively concludes the pharyngitis is of a viral origin, you should send the report back to the provider for further information surrounding the infectious agent.