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87811 COVID 19 Rapid test

R

rcartwright

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6
Location
Elkvilke, IL
I am trying to bill 87811 to Medicare for the rapid COVID test and they are denying it stating that the CLIA # the provider has does not support this test. Is there something special we need to do to bill this? The McKesson rep states that it is a billable code.
 
I am having the same issue, but only with UHC products. I have billed it both ways for UHC and they are both denying. I cannot find any up to date information on the UHC provider site. Does anyone know if uhc is now wanting a different modifier?
 
For the rapid test where we swab the nose, mix it with a liquid and then put it on a cartridge and a machine reads the results, we have been using 87426-QW. If it has the Flu A&B, I would use the code 87428-QW. We haven't had any issues with these codes.
 
Our rapid test is only for Covid, cpt 87811, direct optical. McKesson is also stating this is the correct code with the QW modifier. Is anyone getting paid on this code by UHC?
 
klane7 said:
Our rapid test is only for Covid, cpt 87811, direct optical. McKesson is also stating this is the correct code with the QW modifier. Is anyone getting paid on this code by UHC?
Click to expand...
I am having the same issue with all payers for this CPT. I just contacted McKesson for some guidance. Perhaps we are using the incorrect CPT?
 
United Healthcare states they will deny the testing code or vaccine if other services are also billed on the same claim. I am wondering if other payers are also following this
 
Update: I found more information to support when to use of Z11.52 & Z20.822 since there is a lot of conflicting info out there.
AAFP says Z11.52 should be used when patients being screened for COVID-19 have no symptoms, no known exposure to the virus, and test results that are either unknown or negative.
https://www.aafp.org/journals/fpm/b... example, Z11.,are either unknown or negative
BCBS says to use Z11.52 for asymptomatic patients.
https://www.bcbsm.com/content/dam/p...provider/alerts/icd-10-cm-diagnosis-codes.pdf
CDC update states: As a result of the ongoing COVID-19 public health emergency, the Centers for Disease Control and Prevention’s National Center for Health Statistics (CDC/NCHS) is implementing additional codes into the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for reporting to include: • Encounter for screening for COVID-19 (Z11.52) • Contact with and (suspected) exposure to COVID-19 (Z20.822)
https://www.cdc.gov/nchs/data/icd/Announcement-New-ICD-code-for-coronavirus-19-508.pdf

What diagnosis is being used? Make sure you are using an appropriate dx. We started billing 87811 about a month ago and aren't having any issues. You need to make sure you are using on of the following codes, Z20.822 or Z11.52.
Here is the link for a UHC pdf that is current as of 08/20/2021:
 
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We have issues with UHC denying claims through our clearinghouse but the claims seem to process through when I enter them via UHC web portal. Not sure why.
 
rthomas@impcna.com said:
What diagnosis is being used? Make sure you are using an appropriate dx. We started billing 87811 about a month ago and aren't having any issues. You need to make sure you are using on of the following codes, Z20.822 or Z11.52.
Here is the link for a UHC pdf that is current as of 08/20/2021:
Click to expand...
In the pandemic, use of code Z11.52 is not supported. You should only use Z20.822.

 
vinessachilders said:
In the pandemic, use of code Z11.52 is not supported. You should only use Z20.822.

Click to expand...
There is a lot of conflicting info out there.
AAFP says Z11.52 should be used when patients being screened for COVID-19 have no symptoms, no known exposure to the virus, and test results that are either unknown or negative.
https://www.aafp.org/journals/fpm/b... example, Z11.,are either unknown or negative
BCBS says to use Z11.52 for asymptomatic patients.
https://www.bcbsm.com/content/dam/p...provider/alerts/icd-10-cm-diagnosis-codes.pdf
CDC update states: As a result of the ongoing COVID-19 public health emergency, the Centers for Disease Control and Prevention’s National Center for Health Statistics (CDC/NCHS) is implementing additional codes into the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for reporting to include: • Encounter for screening for COVID-19 (Z11.52) • Contact with and (suspected) exposure to COVID-19 (Z20.822)
https://www.cdc.gov/nchs/data/icd/Announcement-New-ICD-code-for-coronavirus-19-508.pdf
 
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