When both Influenza A & B are tested for using A+B differential influenza test do we use 87804 X 1 or 87804 X 2? I'm confused whether there are two tests being ordered or if the test for both A & B is inclusive? Thanks for your feedback.
If you use a product that differentiates between influenza A & B, you should report 87804 twice. When you get two results from a test, you should code for two units.
For payers that do not recognize two units of 87804 and deny the second charge as a duplicate, use modifier 59 on the second 87804 entry. This modifier indicates that a different test was performed to test for a distinct strain.
In Our Office We Were Using 87804+87804 59mod. We Use The Quidel Ab Test. We Recently Found New Information That There Is A Better Code Which Is 87400+87400w/59mod. As The Test We Are Doing Is Better Described By This Code. Hope This Helps. Thanks Nicole Wessell, Cpc
Good point...below is the difference between the two~
CPT code for the rapid flu test
QWhat CPT code should I submit for the rapid flu test?
AIf you are billing for the procedure in which you take a respiratory sample (e.g., throat or nasal swab, nasal aspirate or sputum) and do the rapid test, you should submit 87804, "Infectious agent antigen detection by immunoassay with direct optical observation; Influenza." This is a new code that went into effect Jan. 1, 2002. However, if you are using some other source (e.g., culture material) or technique, which would not generally be considered a "rapid" flu test, you should submit a different code, such as 87400, "Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple step method; Influenza, A or B, each."
From my experience, carriers could have specific policies on how they want this particular lab submitted. Some carriers want the two units...others want two lines w/ mod 59 on the second line. Before we billed certain, "problem child" carriers, I reviewed their medical policies to try to catch any potential denials up front. It's my opinion that this was the implication of this statement. The coding world has become gray, in some areas, due to carrier edits.
We are experiencing issues with this as well. Our Medicaid HMO has requested we provide something to substantiate billing the 87804 twice. Can anyone tell me where I can find something that I can send to them?
Thanks for your help.