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Billing of 86403

  1. #1
    Default Billing of 86403
    Medical Coding Books
    We're getting a CCI edit that states 86403 requires either 36415/36416 to be added. The office is using 86403 for rapid strep tests. Is it safe to have this edit removed since it doesn't apply to the billing scenerio?

  2. #2
    Default Not sure if this helps
    I dont know if this would help but we use 87081 for our rapid strep test, and we dont have any problems.However we dont have Medi-care we are in Peds. but when billing the state insurance (Medi-cal) we add modifier ZS. This is some info I found for the description of the codes.
    Code Description

    87081
    Culture, presumptive, pathogenic organisms, screening only;

    Lay Description
    This is a presumptive screening culture for one or more pathogenic organisms. The methodology is by culture and the culture should be identified by type (e.g., anaerobic, aerobic) and specimen source (e.g., pleural, peritoneal, bronchial aspirates). If a specific organism is suspected, the person ordering the test will typically use common names, such as strep screen, staph screen, etc., to specify the organism for screening. Presumptive identification includes gram staining as well as up to three tests, such as a catalase, oxidase, or urease test. Screenings included in this code are nonmotile, catalase-positive, gram-positive rod bacteria.



    86403
    Particle agglutination; screen, each antibody

    Lay Description
    These tests may be ordered as PA. The specimen is serum. There are several methods used in tandem with PA tests, such as fluorescence enzyme assay and scattered light flow cytometry. Particle agglutination (PA) tests may be performed to evaluate immune status to and diagnosis certain viruses (i.e., measles virus infection Use 86403 to report each separate antibody screen, and 86406 to report each antibody tested according to titer.

  3. #3
    Default Re: 86403
    Unless you are a lab and actually testing blood I don't believe you should be using 86403.

    If you are truly doing a "rapid" strep test in the office using a throat culture you should be using 87880. 87880 is infectious agent detection by immunoassay with direct optical observation; streptococcus, group A. We add a QW to the code because we have a CLIA Certificate and QW indicates that the test is CLIA Waived. (All a QW indicates is that we have a CLIA certificate and that we are certified to do this type of test in the office) Most payers will not cover a non-CLIA Waived test in a Doctor's office.

    Every resource I have shows 87081 as the code you would use for group B using a vaginal swab.
    Barbara Haskins CPC

  4. #4
    Smile
    Quote Originally Posted by bhaskins1 View Post
    Unless you are a lab and actually testing blood I don't believe you should be using 86403.

    If you are truly doing a "rapid" strep test in the office using a throat culture you should be using 87880. 87880 is infectious agent detection by immunoassay with direct optical observation; streptococcus, group A. We add a QW to the code because we have a CLIA Certificate and QW indicates that the test is CLIA Waived. (All a QW indicates is that we have a CLIA certificate and that we are certified to do this type of test in the office) Most payers will not cover a non-CLIA Waived test in a Doctor's office.

    Every resource I have shows 87081 as the code you would use for group B using a vaginal swab.

    I will ditto this response.....

    YTH, CPC

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