CPT 87804 with modifier X{EPSU}

[Squiabro]

This question was posted by someone in Dermatology forum and was suggested to re-post here.

The original question is:

When coding the flu A and B test - we use 87804 and 87804-59 mod?? I have noticed that medicare is denying the second test?? Is this because we are not using the "X" modifiers - if so which one should be used??

 

[kak6]

check both of these web sites, you will understand 87804 and use of QW modifier

http://www.cms.gov/Regulations-and-G...s/waivetbl.pdf

http://www.cms.hhs.gov/CLIA/01_Overview.asp#TopOfPage

 

[acalce]

I am just a student, and have not taken the cpc exam yet. I probably am not understanding the question fully, but shouldn't you use 87400x2?

 

[acalce]

Actually, 87400 & 87400-59?

 

[Squiabro]

Medicare X{EPSU}

CPT 87804 QW, 87804, QW, 59 is the currently the correct way code/bill for Influenza A&B in an office or facility with CLIA Waiver.
I believe the question is which (if any) of Medicare?s X {EPSU} modifiers will replace modifier 59 in this instance.

- XE - Separate Encounter, a service that is distinct because it occurred during a separate encounter,
- XS - Separate Structure, a service that is distinct because it was performed on a separate organ/structure,
- XP - Separate Practitioner, a service that is distinct because it was performed by a different practitioner, and
- XU - Unusual Non-Overlapping Service, the use of a service that is distinct because it does not overlap usual components of the main service

Thank you,

 

[cjc9508]

If you read the definitions of the new X[EPSU] modifiers aren't they more geared for the encounter level noting different encounters or different provider on the same day? I don't believe that these are appropriate. CMS has a great article on when and how to use modifier -59. It has been updated explaining how the new modifiers are used in relation to modifier -59.


http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/downloads/modifier59.pdf