Wiki BCBS Medicare and 87804, 87804-59 issue

[Shana DuBois CPC]

Our office billed Flu tests as 87804 & 87804-59, yet the only payor who refuses to pay for the 2nd (Flu B) test is BCBS Medicare. We are told that if we disagree with their processing, we need to appeal, and frankly, this is a drain of our resources, due to the reimbursement amount allowed, compared to the manpower it takes to submit the shear volume of these appeals. Has anyone else had this issue, and have you found a way to resolve it?

 

[agm@claimsmedinc.com]

Our office billed Flu tests as 87804 & 87804-59, yet the only payor who refuses to pay for the 2nd (Flu B) test is BCBS Medicare. We are told that if we disagree with their processing, we need to appeal, and frankly, this is a drain of our resources, due to the reimbursement amount allowed, compared to the manpower it takes to submit the shear volume of these appeals. Has anyone else had this issue, and have you found a way to resolve it?

Hello Shana,

We used to bill it like 87804x2 with 59 modifier and BCBS Medicare is paying us that way.

 

[Shana DuBois CPC]

Thank you! This is what I was thinking about doing, however, my manager would like more input before we do.

 

[xXxPARAGONxXx]

Our office billed Flu tests as 87804 & 87804-59, yet the only payor who refuses to pay for the 2nd (Flu B) test is BCBS Medicare. We are told that if we disagree with their processing, we need to appeal, and frankly, this is a drain of our resources, due to the reimbursement amount allowed, compared to the manpower it takes to submit the shear volume of these appeals. Has anyone else had this issue, and have you found a way to resolve it?

https://www.aapc.com/codes/coding-n...04-two-flu-tests-three-coding-options-article
https://www.aapc.com/blog/49147-get-multiple-flu-tests-paid/
https://www.aapc.com/discuss/threads/87804-and-modifier-92.29036/
https://www.aetnabetterhealth.com/c...id/texas/pdf/Notice_Multiple_Flu_Tests_TX.pdf

Appears payer dependent.

You could try:
87804, 87804-59
87804, 87804-76
87804, 87804-91

Frankly, I believe 87804, 87804-91 is the most appropriate, but the payer ultimately decides.