Pathology/Lab Coding Alert

Standard flu tests are not the end of the line this year. Your lab may send out -- or perform -- surveillance tests for the novel influenza A (H1N1) outbreak. Lacking a Food and Drug Administration (FDA)- approved test for the novel H1N1 virus, the Centers for Disease Control and Prevention (CDC) developed and issued emergency use authorization (EUA) for such a test.

The EUA expires April 26, 2010, or when the CDC revokes it, whichever is earlier.

"Mainly public health labs perform these tests to confirm H1N1 infection," says Peggy Slagle, CPC, billing compliance coordinator at the University of Nebraska Medical Center in Omaha.

Break Down Guidelines for Public Health Testing If your lab performs novel influenza A (H1N1) confirmatory testing in a public health capacity, you won't bill for the test. "That's why labs don't currently use a CPT code to report the CDC-developed test," Slagle explains.

Federal, state, and county public health authorities govern the requirements for novel influenza A (H1N1) testing for surveillance purposes. The guidelines vary regionally and are subject to frequent change, but generally look something like this:

Provide fee-exempt confirmatory novel influenza A (H1N1) testing only for specimens collected from patients who have acute febrile respiratory illness and meet one of the following criteria:

• positive influenza A test result

• pregnant patient

• hospitalized patient

• two-year-old or younger patient

• healthcare worker

• correctional facility resident or staff

• special case with public health department approval.

Labs may validate and perform the two CDC tests in effect under the EUA:

1. Real-time RT-PCR flu panel. This panel is a first tier test for patients without a positive influenza A test result. If the panel is positive for influenza A and negative for seasonal H1 and H3 subtypes, the laboratory should test the specimen using the following panel.

2. RT-PCR swine flu panel. This panel allows presumptive diagnosis of novel influenza A (H1N1) infection.

Although isolation of novel influenza A (H1N1) through viral culture can confirm infection, the test may not yield timely results for clinical management. That's why the CDC recommends the RT-PCR test for confirmatory testing.

But if your lab performs viral culture for patients who initially don't require confirmatory testing, you should report the service using the appropriate CPT code, such as 87252 (Virus isolation; tissue culture inoculation, observation and presumptive identification by cytopathic effect). Make sure you follow public health guidelines if the viral culture is positive for swine flu.

You can learn more about CDC swine flu testing guidance at www.cdc.gov/h1n1flu/eua.