Pathology/Lab Coding Alert

Question: When is it appropriate to bill multiple units of 87798 as opposed to billing 1 unit of 87801?

AAPC Forum Participant

Answer: Both 87798 (Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; amplified probe technique, each organism) and 87801 (Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; amplified probe(s) technique) describe using one of a number of techniques, such as polymerase chain reaction (PCR), ligase chain reaction (LCR), or signal detection (bDNA) to detect one (in the case of 87798) or multiple (in the case of 87801) infectious microorganisms. Both codes should be used when testing for infectious organisms not specified by another code.

You would report 1 unit of 87798 for detection of a single unspecified agent when there is a single result for the test (one agent, one test, one result). On the other hand, you would report 1 unit of 87801 if you were testing for multiple unspecified agents when the test results are reported in a single result (multiple agents, one test, one result).

In other words, you would only report multiple units of 87798 if the pathologist tested for multiple unspecified agents and there were multiple reports for each individual agent. When this occurs, you may need to append modifier 59 (Distinct procedural service) to each subsequent unit of 87798 to tell the payer your lab has performed multiple tests for multiple unspecified organisms.

Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC