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Wiki Flu and Strep test

Knm5800

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12
Location
Wimauma, FL
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I received my first denial for billing 87880 and 87804 (x2) together on a claim. This particular MCD payer denied the 87804 (x2) stating, "reimbursement included in another code per CMS/AMA/Medical guidelines.
I attached a different ICD10 to each test on the original claim. Has anyone else seen this denial and have you been successful in appealing it?
 
We went around and around with Sunshine Health over this. They will no longer pay for a Strep and Flu together citing a policy that it is not medically necessary (they will only pay the Strep). Additionally, they now only allow the flu test during certain months.

I don't have a copy of the exact policy they sent ... but I found this link to one that says the same thing. So far, Sunshine is the only payer we have doing this.

https://www.healthnet.com/static/general/unprotected/pdfs/national/policies/FluandStrepTesting.pdf
 
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