Pathology/Lab Coding Alert

Question: We use the BinaxNOW influenza A and B testing kit, which gives results for both influenza A and influenza B. Is it acceptable to bill two units of service for this test, and if so, why do we get denials? Michigan Subscriber Answer: Yes, you can bill two units of service for the BinaxNOW influenza A and B if you document test results (positive or negative) for each organism. The correct code is 87804 (Infectious agent antigen detection by immunoassay with direct optical observation; influenza). If you-re having problems with payment, you should check with your payer to ensure that you-re coding according to its requirements. For instance, some payers ask that you use units (87804 x 2), while others request that you list each code on a separate line and report a modifier on the second code. For example, different payers request modifier 59 (Distinct procedural service) or 91 (Repeat clinical diagnostic laboratory test). Ask your carrier for reporting instructions for this test. Don't miss: This test is approved for use in waived-status laboratories under the Clinical Laboratory Improvement Amendments. If you-re performing this test in a CLIA-waived lab, you should append modifier QW (CLIA-waived test).