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Cristina Posted Tue 24th of October, 2017 09:09:19 AM
I have a payer Sunshine State that states CMS guidelines does not allow 87880 and 87804 to be completed in the same visit. Could you clarify this rule?
SuperCoder Answered Wed 25th of October, 2017 02:30:10 AM

Hi Cristina,

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.

Moreover, rapid influenza tests have inadequate value when the overall prevalence is less than or equal to 10%. Generally, this is at the beginning and end of the season as well as during the summer months. The Centers for Disease Control (CDC) states it is not required for a health care provider who believes a patient has influenza to test before prescribing antivirals.

Hope this helps!

 

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