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87804 and modifier 92

  1. #1
    Default 87804 and modifier 92
    Medical Coding Books
    Can modifier 92 be used with87804? Given in office.

  2. #2
    Default Modifier 92
    I don't believe that modifier 92 is the correct modifier to use with 87804 Influenza. If you are doing both the Influenza A and B tests then you would bill 87804 and 87804-59 to get paid for both. Most insurances I have found will pay for both when you bill this way. I hope this helps!

  3. Default
    Medicare will not pay with the 59 modifier on the second 87804. Since 87804 cannot be quantity billed we have billed Medicare as 87804 and 87804-76.

  4. #4
    Columbia, MO
    The correct modifier would be the 91 for repeat lab

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    North Carolina
    I find that this can become carrier discretion. My carriers recommend 59. CPT Assistant, dated 5-2009, also recommends this...

    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, may be used to indicate that the two results represent separate services (codes 87804 and 87804-59).

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