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Jill Posted Fri 03rd of November, 2017 16:44:02 PM
I saw the post regarding billing the 87804 and 87880 at the same visit. WE have the same problem. You mentioned the CDC guidelines, but has CMS adopted this policy yet? When we put those 2 codes together in the CCI edits, Supercoder says there is no edit, so why would the insurance company say we can't bill those 2 at the same visit? Maybe in the future, there will be a change to the coding guidelines, but I don't see any rules at this time stating that we can't bill them together.
SuperCoder Answered Mon 06th of November, 2017 06:31:06 AM

Hi,

 

The logic behind non completion of CPT code 87880 and 87804 on same visit is:

Clinical research and medical associations consistently suggest that patients with streptococcus, group A present uniquely discrete, signs and symptoms inconsistent with influenza. Therefore, testing for both is not medically necessary because of the improbability of concurrently contracting influenza and streptococcus.

 

There is no CCI conflict for these codes and could not find any CMS link that states bundling of these codes. The payment is payor specific, I have seen some payors deny the payment. 

 

Thanks!

 

 

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