Wiki 87800

[klapetri@ilovemygyn.com]

When billing 87491 and 87591 should we also include 87800? for Medicare plans?

 

[nielynco]

When billing 87491 and 87591 should we also include 87800? for Medicare plans?

Are you a lab billing for these services? And if are the additional organisms to be tested for documented? If you are physician practice, you would not bill for the lab tests unless you are qualified to perform them or are billing on behalf of the lab in which case a modifier -90. There is a Medicare coding guidance on testing for STD's as follows:

Effective for claims with dates of service on and after November 8, 2011, the claims processing instructions for payment of screening tests for STI will apply to the following HCPCS codes:
• Chlamydia: 86631, 86632, 87110, 87270, 87320, 87490, 87491, 87810, 87800 (used for combined chlamydia and gonorrhea testing)
• Gonorrhea: 87590, 87591, 87850, 87800 (used for combined chlamydia and gonorrhea testing)
• Syphilis: 86592, 86593, 86780
• Hepatitis B: (hepatitis B surface antigen): 87340, 87341

 

[jasminkaberdik]

I code Chlamydia testing as 87491, and Gonorrhea testing as 87591. Should I be using 87800 instead?
When you say 87800 is used for combined chlamydia & gonorrhea testing, do you mean when there is
one result for both? I am confused. Thank you.

CHLAMYDIA TRACHOMATIS PCR NEGATIVE Ref: Negative [600]
NEISSERIA GONORRHEA PCR NEGATIVE Ref: Negative [600]
Eval: Chlamydia/Gonococcus PCR test uses Polymerase Chain Reaction (PCR)
Eval: technology to detect Chlamydia trachomatis and Neisseria gonorrhoeae
Eval: nucleic acid (DNA). This test is an FDA approved qualitative test.
Comment: This test is intended as an aid in the diagnosis of chlamydial and
gonococcal disease in both symptomatic and asymptomatic individuals
and is FDA approved for self-collected urine specimens,
self-collected (in a clinical setting) vaginal swabs, and
clinical-collected endocervical and vaginal sources. In-house test
validation was performed on clinical-collected throat and anorectal
sources only. Please be aware that "self-collected" swabs may
produce false negative results, and require clinical correlation
with appropriate clinical follow-up.

This Chlamydia/Gonococcus Test utilizes the Polymerase Chain
Reaction (PCR) technology to detect Chlamydia trachomatis and
Neisseria gonorrhoeae DNA in male and female urine, and, in "self"
or "clinical" collected specimens from vaginal, endocervical,
throat, and anorectal swabs collected in cobas PCR Media, or, from
cervical specimens collected in PreservCyt solution.