Pathology/Lab Coding Alert

Learn these secrets for coding Quickvue, Binax products

You should know that labs often test for two strains of influenza--A and B. Watch for the strain, and you could save your lab $17 per test.

Not all influenza tests that qualify for 87804 (Infectious agent antigen detection by immunoassay with direct optical observation; influenza) deserve multiple-unit coding--and the same product doesn't always deserve multiple coding. Follow our experts- advice to make complex flu-test coding easy.

Report 87804-QW for Optical Analysis

Code 87804 describes the rapid flu test approved by the Food and Drug Administration that labs with Clinical Laboratory Improvement Amendment (CLIA) waived status can use, says Kevin Perryman, administrator at the office of Teri Perryman, MD, in Kerrville, Texas. Use modifier QW (CLIA waived test) to show that the test is approved for a lab with waived-status CLIA certification.

You should not use 87804 for all influenza tests because CPT provides several different flu-test codes. (See -Capture Proper Flu Test Pay -quot; Here's How- on page 29 to learn other influenza test codes.) Use 87804 for detection by visual identification rather than by more complex methods that some labs use, such as immunofluorescence (87275, Infections agent antigen detection by immunofluorescent technique; influenza B virus; or 87276, - influenza A virus) or enzyme immunoassay (87400, Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; Influenza, A or B, each).

Apply 87804 Coding Rule to 3 Flu Products

When your lab uses an A and B influenza test, you should bill multiple units of 87804 when appropriate. -The pharmaceutical representatives say that you can bill the same code twice for some of the tests,- says Deb Chandler, BA, CPC, ACS-FP, CCP, with Family Physician Associates in Columbus, Ohio.

Key: Influenza A and influenza B are two separate strains identified by two separate tests available in some products. You should report 87804 per strain or per test result.

Here's how you should apply the -1 Result = 1 Code- rule to three tests:

Product 1: For an optical test that does not identify the influenza strain, bill one unit of 87804. Quidel QuickVue Influenza Test picks up only the presence of influenza with a single positive/negative result. Because the test gives you one result, you should report one unit of 87804.

If you use a product that differentiates between influenza A and B, you should report 87804 twice. When you get two results from a test, you should bill two units.

Products 2 and 3: Two products that use a single test device (such as a swab) to test for different strains resulting in two results include:

- Quidel Quickvue Influenza A+B Test
- Binax NOW A&B Test.

Check for Results Before Billing 87804 x 2

Because you bill per result, not per device, don't automatically code two units of 87804 every time you use a Quidel Quickvue Influenza A+B Test or Binax NOW A&B Test kit.
Clinicians do not always require both tests even if the kit can identify two types of influenza.

You code it: Your lab runs the Quidel Quickvue Influenza A+B Test and tests for both strains. Test results indicate:

- positive for influenza A
- negative for influenza B.

Solution: You should code two units of 87804--one code for each result.

Consider 2 Alternatives for 87804 Denial

You may confront variations in the way payers require you to bill multiple units of 87804.

Best practice: Bill two units of 87804 if your payer allows it. Billing the same code more than once is appropriate when you perform testing for two results.

For payers that do not recognize two units of 87804 and deny the second charge as a duplicate, use modifier 59 (Distinct procedural service) on the second 87804 entry. This modifier indicates that the lab performed a different test to look for a distinct strain.

That's what Chandler did when her practice had problems billing two units of 87804. -We-ve been using modifier 59 to indicate that the second test is separate from the first with pretty good results,- Chandler says.

Fallback method: Because some contractor and insurer computer systems do not recognize modifier 59, you may instead need to use modifier 91 (Repeat clinical diagnostic laboratory test). In this case, you should ask the payer if modifier 91, which is uniquely applicable to laboratories, would be a reasonable alternative, suggests the American Society for Microbiology in its -Q & A- on 87804 and 87804-59.

Before using this coding method, which contradicts current coding guidelines, obtain a written recommendation from your payer.

Use Modifier QW, Too

If your lab operates under the Clinical Laboratory Improvement Amendment certificate of waiver, you should report 87804 with modifier QW (CLIA waived test). Not doing so could be another source of 87804 denials.