Advanced Search

Primary Care Coding Alert

Dual 87804 Results:

AMA Issues Modifier Directive

Published on Thu Oct 07, 2010

Question: When reporting 87804 to describe testing for rapid influenza virus A&B, should the second test have modifier 91? Illinois Subscriber Answer: Per the AMA, the correct choice for two rapid influenza test results (87804, Infectious agent antigen detection by immunoassay with direct optical observation; influenza) is modifier 59 (Distinct procedural service). "When two units of code 87804 are submitted, modifier 59 may be used to indicate that the two results represent separate services (codes 87804 and 87804-59)," according to CPT Assistant (May 2009). Because the same CPT code describes the rapid testing of both strains, you should use modifier 59 to indicate separate results. Alternatively, the payer may prefer no modifier and two units of 87804 reported once (87804 x 2). If a payer instructs you to instead use modifier 91 (Repeat clinical diagnostic laboratory test) with two distinct influenza tests, keep a copy of the guideline in your [...]
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in your eNewsletter
  • 6 annual AAPC-approved CEUs*
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more
*CEUs available with select eNewsletters.

Other Articles in this issue of

Primary Care Coding Alert

View All