ED Coding and Reimbursement Alert

Question: A patient reports to the ED worried about a fever and chills; to rule out the H1N1 flu, the physician orders an immunoassay influenza screening.The patient does not have any type of flu. Should I report modifier 26 with 87804?

Tennessee Subscriber

Answer: You should not report 87804 or modifier 26 (Professional component) on this claim. When the ED physician orders a lab test to check for flu, you should consider the work part of the overall E/M.

So if the notes indicate a level-two E/M, report 99282 (Emergency department visit for the evaluation and management of a patient &) for the service.

Remember to append 780.60 (Fever, unspecified) to the E/M to indicate the patients presenting symptoms, and V73.89 (Other specified viral diseases) to identify the type of screening.

Explanation: When the ED physician orders a lab test, the hospital charges for it. So the facility would report 87804 (Infectious agent antigen detection by immunoassay with direct optical observation; influenza) for this encounter.

If the patient did have the H1N1 virus, diagnosis coding will be a little tricky. The illness is so new that ICD-9 does not have a specific diagnosis code for it.

Check with your payer to see what diagnosis codes it wants you to use for H1N1 patients. Many payers are instructing coders to use 487.1 (Influenza; with other respiratory manifestations) for confirmed H1N1 flu patients.