So which code for influenza – A or B? If your lab test aids you in answering the A/B question, you might be able to report two units of the test code. Watch out: Missing the second test could cost your lab up to $27 in lost revenue.
Here are some tips that can help you get your flu coding on course to get all the pay you deserve:
Code 87400 for 'Each'
If your lab carries out a test that looks for influenza A or B antigens using enzyme immunoassay (EIA) technique, you should report 87400. The specimen source for this test may include blood, nasopharyngeal wash, throat swab, or sputum for that matter.
Irrespective of whether positive or negative, if the EIA antigen test involves results for A and for B, you should list 87400 x 2.
Word of caution: If the EIA provides a qualitative determination for influenza A and B however does not differentiate between the two strains, you should not code 87400. For example, ZymeTx Zstatflu gives a positive reading in the presence of A or B antigens, with no distinction.
Try this: In its place, you should report the test using unspecified code 87449.
87804 Warrants two
For an influenza test that uses an immunoassay leading to an observable result, say for instance a color change, you should report 87804. For a test that doesn't identify the influenza strain -- one that involves a single positive or negative result for influenza -- report one unit of 87804.
Opportunity: The 87804 definition does not specify 'each' for influenza A and B; however you may be able to bill for both.
If you use a test differentiates between influenza A and B and you document both results, you should code 87804 twice.
You may figure out differences in how payers want you to report multiple units of 87804. Take a look at how to decide which method to use:
Best practice: If the payer allows it, report two units of 87804. Many MACs allow you to report 87804 x 2, since the MUEs limits you to two units of 87804.
For payers that deny the second 87804 charge as a duplicate, add modifier 59 on the second 87804 entry. According to the May 2009 CPT Assistant, you should use modifier 59 when separate results are reported for different species or strains that are described by the same CPT code.
Fallback technique: In some rare instances, such as certain state Medicaid providers, your payer may tell you to use modifier 91 on the second listing of 87804.
Report 87254 per virus strain
Labs may carry out a rapid culture and direct antigen test to distinguish type A and B influenza. Often doctors order this test since it provides a quick response and high sensitivity.
The right code for this test method is 87254. A negative test result indicates no influenza infection, whereas a positive result indicates the presence of influenza A or B, as specified. Since the test is for influenza A and B, you should report two units of 87254 for the test.
86710 depends on antibody
Doctors may order influenza antibody test(s) on a blood sample to help figure out influenza A or B infection. The presence of IgG antibody shows prior exposure to the virus, while IgM antibody presence shows present acute infection. The method may be enzyme-linked immunosorbent assay (ELISA) or other methods. The key is that this is an antibody test, and not an antigen test. Code this service as 86710 (Antibody; influenza virus).
Capture two or four: Just like the other test codes, if the lab tests for influenza A and B, you can list the code twice (86710 x 2). However that is not all for the antibody test. Since the lab may test for IgG and IgM, you can use a separate code for each of those antibodies. If you test for each antibody for each influenza strain, you will have four units of 86710.
Here are some tips that can help you get your flu coding on course to get all the pay you deserve:
Code 87400 for 'Each'
If your lab carries out a test that looks for influenza A or B antigens using enzyme immunoassay (EIA) technique, you should report 87400. The specimen source for this test may include blood, nasopharyngeal wash, throat swab, or sputum for that matter.
Irrespective of whether positive or negative, if the EIA antigen test involves results for A and for B, you should list 87400 x 2.
Word of caution: If the EIA provides a qualitative determination for influenza A and B however does not differentiate between the two strains, you should not code 87400. For example, ZymeTx Zstatflu gives a positive reading in the presence of A or B antigens, with no distinction.
Try this: In its place, you should report the test using unspecified code 87449.
87804 Warrants two
For an influenza test that uses an immunoassay leading to an observable result, say for instance a color change, you should report 87804. For a test that doesn't identify the influenza strain -- one that involves a single positive or negative result for influenza -- report one unit of 87804.
Opportunity: The 87804 definition does not specify 'each' for influenza A and B; however you may be able to bill for both.
If you use a test differentiates between influenza A and B and you document both results, you should code 87804 twice.
You may figure out differences in how payers want you to report multiple units of 87804. Take a look at how to decide which method to use:
Best practice: If the payer allows it, report two units of 87804. Many MACs allow you to report 87804 x 2, since the MUEs limits you to two units of 87804.
For payers that deny the second 87804 charge as a duplicate, add modifier 59 on the second 87804 entry. According to the May 2009 CPT Assistant, you should use modifier 59 when separate results are reported for different species or strains that are described by the same CPT code.
Fallback technique: In some rare instances, such as certain state Medicaid providers, your payer may tell you to use modifier 91 on the second listing of 87804.
Report 87254 per virus strain
Labs may carry out a rapid culture and direct antigen test to distinguish type A and B influenza. Often doctors order this test since it provides a quick response and high sensitivity.
The right code for this test method is 87254. A negative test result indicates no influenza infection, whereas a positive result indicates the presence of influenza A or B, as specified. Since the test is for influenza A and B, you should report two units of 87254 for the test.
86710 depends on antibody
Doctors may order influenza antibody test(s) on a blood sample to help figure out influenza A or B infection. The presence of IgG antibody shows prior exposure to the virus, while IgM antibody presence shows present acute infection. The method may be enzyme-linked immunosorbent assay (ELISA) or other methods. The key is that this is an antibody test, and not an antigen test. Code this service as 86710 (Antibody; influenza virus).
Capture two or four: Just like the other test codes, if the lab tests for influenza A and B, you can list the code twice (86710 x 2). However that is not all for the antibody test. Since the lab may test for IgG and IgM, you can use a separate code for each of those antibodies. If you test for each antibody for each influenza strain, you will have four units of 86710.
