87804, help please!?

nreynolds

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I am having issues billing the Flu test A&B. I was told to bill the 87804, once for the type A and then again for the type B. Both with the QW modifier and the type B with a 59 modifier. I have been only getting paid for only one from Medicare and the other is not being covered. Is there something I am missing or should do differently?
 

btadlock1

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I am having issues billing the Flu test A&B. I was told to bill the 87804, once for the type A and then again for the type B. Both with the QW modifier and the type B with a 59 modifier. I have been only getting paid for only one from Medicare and the other is not being covered. Is there something I am missing or should do differently?
You'll probably have to have it manually reviewed...try billing one without the 59 modifier next time, and see if that helps - it's less likely to look like a duplicate charge. ;)
 

btadlock1

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Medicare wants this billed as 1 line item with 2 units and a -59
You should double-check the rules with your MAC - more than likely, they only want you to add the -59 modifier to the second 87804/QW. You only need to distinguish one of them as a "distinct procedural service"; it's implied, on the other one. Here's an article I found:

"87804 Warrants two


For an influenza test that uses an immunoassay leading to an observable result, say for instance a color change, you should report 87804. For a test that doesn't identify the influenza strain -- one that involves a single positive or negative result for influenza -- report one unit of 87804.


Opportunity: The 87804 definition does not specify 'each' for influenza A and B; however you may be able to bill for both.


If you use a test differentiates between influenza A and B and you document both results, you should code 87804 twice.


You may figure out differences in how payers want you to report multiple units of 87804.

Take a look at how to decide which method to use:


Best practice: If the payer allows it, report two units of 87804. Many MACs allow you to report 87804 x 2, since the MUEs limits you to two units of 87804.


For payers that deny the second 87804 charge as a duplicate, add modifier 59 on the second 87804 entry. According to the May 2009 CPT Assistant, you should use modifier 59 when separate results are reported for different species or strains that are described by the same CPT code.


Fallback technique: In some rare instances, such as certain state Medicaid providers, your payer may tell you to use modifier 91 on the second listing of 87804."

http://health.ezinemark.com/pathology-coding-do-not-miss-pay-for-second-flu-testing-322e8a7d504.html
 
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