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87804 FLU Test

  1. #1
    Question 87804 FLU Test
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    Our office has been billing the 87804 as a quantity of 1 until recently when I discovered our test are for both strains A&B. I have been billing for this and only changing the quantity and adding notes that it is for both A&B and the payer's have been paying on this. However, a colleague recently suggested I use a modifier with this as well but was not certain what modifier should be used. Is this correct, should a modifier be added, and if so, which one? Thanks so much for the help!

  2. Default 87804 Flu
    I was just asked this same question. The supply rep says we should bill with modifier 59. I dont happen to agree as the same test uses 2 different solutions. Did you get any other responses??

    Linda P

  3. #3
    Location
    North Carolina
    Posts
    3,126
    Default
    http://medicalnewswire.com/cgi-bin/a...t=41&perpage=4

    Our carriers require modifier 59 (most) and have been successful receiving reimbursement. Other regions require modifier 91. It boils down to carrier specific guidelines.

  4. #4
    Default
    We are coding 87804QW For Influenza A
    87804-59 QW for Influenza B

    Modifier 59 to indicate that the code is for a unique and distinct test

    QW to indicate that our office is CLIA Waived (Most of our payors will not pay for "lab" tests in the office without CLIA Certification)

    Hope this helps...
    Barbara Haskins CPC

  5. #5
    Default Influenza A+B Testing
    I was just looking up information today on the Quidel Website. We have an influenza A+B test kit. Apparently it is one test strip that gives you the results for both A&B in separate windows. The Ref# is 20183. According to their site, if the provider specifies that he wants results for both A&B I can code
    87804QW AND 87804QW, 59.
    which would result in two charges for the test. Is this accurate? The provider must specify in his order that he wants both results though, in order for me to charge twice, correct?


    http://www.quidel.com/products/reimbursementinfo.php



    Thanks
    Heather
    Heather Winters, CPC, CFPC

  6. #6
    Default
    You are correct on all counts. If the Physician orders both A & B then you can code for both.
    Some commercial carriers will pay for both, some will not. I have had some success with written appeals in getting the second test paid.
    87804QW AND 87804QW, 59 is the correct way to code.
    Hope this helps!
    Barbara Haskins CPC

  7. #7
    Default Medicare
    Do you know if Medicare is covering both?
    Heather Winters, CPC, CFPC

  8. #8
    Default twice 87804
    See supporting documentation:

    http://www.medscape.com/viewarticle/587649
    New instructions in the microbiology section indicate that, when separate results are reported for different species or strains of organisms, each result should be coded separately. Use modifier 59 when separate results are reported for different species or strains that are described by the same code. For most family physicians, this may only be relevant in one instance: reporting codes 87804 and 87804-59 when testing for both Influenza A and B.
    http://blogs.aafp.org/fpm/gettingpaid/tags/medicare
    hen providing in-office testing for influenza, code 87804QW represents CLIA-waived testing for influenza by immunoassay with direct optical observation. Most rapid tests do not differentiate between Influenza A and B. However, for those that do produce two separate results, payers may accept 87804QW on one claim line and 87804QW59 on a separate claim line. As always, you should check with your individual payers for specific coverage and billing guidelines.
    Heather Winters, CPC, CFPC

  9. Default flu test
    Quote Originally Posted by jdenniston View Post
    Our office has been billing the 87804 as a quantity of 1 until recently when I discovered our test are for both strains A&B. I have been billing for this and only changing the quantity and adding notes that it is for both A&B and the payer's have been paying on this. However, a colleague recently suggested I use a modifier with this as well but was not certain what modifier should be used. Is this correct, should a modifier be added, and if so, which one? Thanks so much for the help!
    When you receive payment, do they pay for more than just one unit?

  10. Cool flu test A & B
    Quote Originally Posted by bhaskins1 View Post
    You are correct on all counts. If the Physician orders both A & B then you can code for both.
    Some commercial carriers will pay for both, some will not. I have had some success with written appeals in getting the second test paid.
    87804QW AND 87804QW, 59 is the correct way to code.
    Hope this helps!
    do you know if government payers are recognizing the A & B difference? are they paying more than for just one test?

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