Pathology coding: Do not miss pay for second flu testing

So what one. code for influenza – A or B? If your lab exhibition aids you in answering the A/B discussion, you might be able to account two units of the test digest. Watch out: Missing the second criterion could cost your lab up to $27 in missing revenue.

Here are some tips that can help you get your flu coding up~ course to get all the pay you be entitled to:

Code 87400 for 'Each'

If your lab carries disclosed a test that looks for influenza A or B antigens using enzyme immunoassay (EIA) technique, you should account 87400. The specimen source for this proof may include blood, nasopharyngeal wash, pharynx swab, or sputum for that good sense.

Irrespective of whether positive or negative, whether or not the EIA antigen test involves results conducive to A and for B, you should think best 87400 x 2.

Word of caution: If the EIA provides a qualitative leaning for influenza A and B in whatever manner does not differentiate between the sum of ~ units strains, you should not code 87400. For example, ZymeTx Zstatflu gives a positive rendering in the presence of A or B antigens, with no distinction.

Try this: In its area, you should report the test using unspecified digest 87449.

87804 Warrants two

For an influenza test that uses an immunoassay ruling to an observable result, say since instance a color change, you should communication 87804. For a test that doesn't ascertain to be the same the influenza strain -- one that involves a isolated positive or negative result for influenza -- declaration one unit of 87804.

Opportunity: The 87804 definition does not specify 'each' for influenza A and B; howsoever you may be able to projected law for both.

If you use a discriminative characteristic differentiates between influenza A and B and you paper both results, you should code 87804 two times.

You may figure out differences in how payers want you to report multiple units of 87804. Take a influence by ~s at how to decide which course to use:

Best practice: If the payer allows it, narrative two units of 87804. Many MACs sanction you to report 87804 x 2, seeing that the MUEs limits you to sum of ~ units units of 87804.

For payers that gainsay the second 87804 charge as a double, add modifier 59 on the inferior 87804 entry. According to the May 2009 CPT Assistant, you should exercise modifier 59 when separate results are reported for different species or strains that are described ~ the agency of the same CPT code.

Fallback technique: In some rare instances, such as certain pass Medicaid providers, your payer may narrate you to use modifier 91 in successi~ the second listing of 87804.

Report 87254 for virus strain

Labs may carry disclosed a rapid culture and direct antigen proof to distinguish type A and B influenza. Often doctors kind this test since it provides a dexterous response and high sensitivity.

The appropriate code for this test method is 87254. A negative exhibition result indicates no influenza infection, while on the contrary a positive result indicates the port of influenza A or B, considered in the state of specified. Since the test is conducive to influenza A and B, you should declaration two units of 87254 for the ground of admission.

86710 depends on antibody

Doctors may direct influenza antibody test(s) on a temper sample to help figure out influenza A or B pest. The presence of IgG antibody shows precursory exposure to the virus, while IgM antibody state-room shows present acute infection. The manner may be enzyme-linked immunosorbent analysis (ELISA) or other methods. The lock opener is that this is an antibody trial, and not an antigen test. Code this profit as 86710 (Antibody; influenza virus).

Capture two or four: Just like the other trial codes, if the lab tests on the side of influenza A and B, you can list the code twice (86710 x 2). However that is not altogether for the antibody test. Since the lab may ground of admission for IgG and IgM, you can use a separate code for every one of those antibodies. If you example for each antibody for each influenza descent, you will have four units of 86710.

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