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positive strep

Paula Posted Mon 18th of August, 2014 17:47:29 PM

87880. are we only allowed to bill the 87880 1 unit. Is there another code to bill because
it is positive..
what about mono, too. 86308 1 unit?
what about Flu 87804? should these labs have a 59 modifier if done on same patient?
We have a clia so should all of these codes have a QW?

SuperCoder Answered Mon 18th of August, 2014 21:33:02 PM

For the rapid strep test, you should report 87880 (Infectious agent detection by immunoassay with direct optical observation; Streptococcus, group A) with modifier QW (CLIA-waived test). Adding modifier QW means that the test is so simple that little risk of error exists, so your physician can perform it in the office without obtaining a higher-level certificate. Include a diagnosis supporting the need for the test. For a negative result, report a choice such as 462; for a positive result, submit 041.01.

86308 (Heterophile antibodies; screening) for the screening and 075 (Infectious mononucleosis) appended to 86308. Report 86308 in conjunction with a venipuncture or blood draw code.

CPT 87804 describes the rapid flu test approved by the FDA requiring Clinical Laboratory Improvement Act (CLIA) –waived status. When coding 87804, you should append modifier QW (CLIA– waived test) to the CPT. If test differentiates between influenza A&B, report 2 units of 87804.Per the AMA, the correct choice for two rapid influenza test results (87804, Infectious agent antigen detection by immunoassay with direct optical observation; influenza) is modifier 59 (Distinct procedural service).

"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)," according to CPT Assistant (May 2009). Because the same CPT code describes the rapid testing of both strains, you should use modifier 59 to indicate separate results. Alternatively, the payer may prefer no modifier and 2 units of 87804 reported once (87804 x 2).

If a payer instructs you to instead use modifier 91 (Repeat clinical diagnostic laboratory test) with two distinct influenza tests, keep a copy of the guideline in your compliance binder. Use modifier 91 when a patient's treatment requires repeating the same lab test on the same day to obtain subsequent results. "An example is repeated blood testing for the same patient, using the same CPT code, performed at different intervals during the same day (e.g., initial and three subsequent potassium levels)," states the AMA in "Coding Brief: Rapid Influenza Virus A and B Testing (Code 87804)".For positive flu see 487-488 diagnosis code series.

http://www.supercoder.com/coding-newsletters/my-pediatric-coding-alert/reader-questions-dual-87804-results-ama-issues-modifier-directive-94737-article

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