Oncology & Hematology Coding Alert

Question: How can we code for immunoassay tests for influenza? Is it incorrect to submit more than two units of 87804? How is this code different from 87502? Have there been recent amendments for 87502?

Codify Subscriber

Answer: You should preferably report 87804 (Infectious agent antigen detection by immunoassay with direct optical observation; Influenza) for immunoassay testing of influenza. Immunoassay testing is a commonly performed service in outpatient practices.

Count the strains: If you perform the test for both strains (A and B) of the flu, you will typically report 87804 twice. Many carriers allow you to report 87804 x 2 without a problem, because the medically unlikely edits (MEUs) that Medicaid and some other payers utilize to auto-deny second and subsequent line items limit you to two units of 87804. This means that your carrier will process two units of the code but would most likely auto-deny three or more units billed together.

Check payer preference: For payers that do not recognize two units of 87804 and deny the second charge as a duplicate, use modifier 59 (Distinct procedural service) on the second 87804 entry. This modifier indicates that a different test was performed to test for a distinct strain.

Code 87502: For nucleic acid testing, you submit code 87502 (Infectious agent detection by nucleic acid [DNA or RNA]; influenza virus, for multiple types or sub-types, includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, first 2 types or sub-types). The codes 87502 and 87804 differ in methodology of testing for influenza.

The 2016 update: CPT® 2016 revises 87502 to clarify that the code includes multiplex reverse transcription, if performed. The code revision in 2016 specifies that the multiplex reverse transcription is optional, so you can accurately use the code with or without that step.