Wiki Rapid A and B influenza test

Create Wiki
We code 87804 and 87804-59 if both A and B are tested and results documented. You need modifer -QW for Medicare patients. The product we use is "Quick Vue Influenza".
 
our vaccine rep inform us to code 87804 and 87804(-91) because we are billing for both A and B. we just started to bill this, not sure of reimbursement yet

Nickie, CPC
 
We called Medicare and they said
When Medicare patients are being tested via rapid testing for influenza the sites are billing 87804 influenza A AND 87804 influenza B. Same CPT but these are two different strains and pts should be tested for both.
When we billed Medicare for both of these CPTs they were denied as duplicate so claims were resent with a 59 modifier (showing a separate and distinct procedure) These should have been billed with a 91 modifier this indicates that the provider performed multiple or “repeat procedures” to a patient on the same day. (91 modifier is used for clinical lab tests only, such as the rapid testing) I found this on the Medicare website under How to Avoid Duplicate Claim Denials for Repeat Procedures.
 
sammie06 said:
We called Medicare and they said
When Medicare patients are being tested via rapid testing for influenza the sites are billing 87804 influenza A AND 87804 influenza B. Same CPT but these are two different strains and pts should be tested for both.
When we billed Medicare for both of these CPTs they were denied as duplicate so claims were resent with a 59 modifier (showing a separate and distinct procedure) These should have been billed with a 91 modifier this indicates that the provider performed multiple or “repeat procedures” to a patient on the same day. (91 modifier is used for clinical lab tests only, such as the rapid testing) I found this on the Medicare website under How to Avoid Duplicate Claim Denials for Repeat Procedures.
Click to expand...

This makes no sense since you would be testing for different strains so it is technically a different test - not a repeat test; just happens that there is one CPT code that describes both A and B. We have not had any denials from our carrier as of yet, so i will continue to use -59.
 
I agree with Lisa~

Excerpt from CPT Assistant...(5-09)

Whether to report one or two units of code 87804, Infectious agent antigen detection by immunoassay with direct optical observation; influenza, varies according to the type of rapid testing method used distinguishing influenza A from influenza B. The rapid detection of influenza virus types A and B may be part of two entirely separate procedures or may be included within the same test device. If the assays provide two separate results (ie, a result for influenza virus A and a result for influenza virus B), it would be appropriate to report two units of code 87804. When two units of code 87804 are submitted, modifier 59, Distinct Procedural Service, may be used to indicate that the two results represent separate services (codes 87804 and 87804-59).

Modifier 59 Versus Modifier 91

For laboratory reporting purposes, modifier 59 is used, for example, to report procedures that are distinct or independent, such as performing the same procedure (that uses the same procedure code) for testing of a different specimen or different strain. Use modifier 59 when separate results are reported for different species or strains that are described by the same CPT code. This advice should serve to clarify the use of the modifier in these instances.

As a matter of differentiation, modifier 91, Repeat Clinical Diagnostic Laboratory Test, is used when, in the course of treating a patient, it is necessary to repeat the same laboratory test on the same day to obtain subsequent test results. An example is repeated blood testing for the same patient, using the same CPT code, performed at different intervals during the same day (eg, initial and three subsequent blood potassium levels).
 
You must log in or register to reply here.
Top