ED Coding and Reimbursement Alert

Question: A patient reports to the ED worried about a fever and chills; to rule out the H1N1 flu, the physician orders an immunoassay influenza screening.The patient does not have any type of flu. Should I report modifier 26 with 87804? Tennessee Subscriber Answer: You should not report 87804 or modifier 26 (Professional component) on this claim. When the ED physician orders a lab test to check for flu, you should consider the work part of the overall E/M. So if the notes indicate a level-two E/M, report 99282 (Emergency department visit for the evaluation and management of a patient &) for the service. Remember to append 780.60 (Fever, unspecified) to the E/M to indicate the patients presenting symptoms, and V73.89 (Other specified viral diseases) to identify the type of screening. Explanation: When the ED physician orders a lab test, the hospital charges for it. So the facility would report [...]