Pathology/Lab Coding Alert

Question: I work in a CLIA-waived lab, and we use an influenza test kit that provides a visual result as positive or negative for influenza A and influenza B using a single specimen. Should I report 87275 and 87276?

Kentucky Subscriber

Answer: No, you should not code 87275 (Infectious agent antigen detection by immunofluorescent technique; influenza B virus) and 87276 (… influenza A virus).

Those two codes are not for tests that you can perform in a waived lab under the Clinical Laboratory Improvement Amendments (CLIA). Also, the visual observation method you describe does not match the 87275 and 87276 code descriptors.

The correct code for the test you describe is 87804 (Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; Influenza). Because you are a CLIA-waived lab, you need to report the code with modifier QW (CLIA waived test).

Because you state that the test you run determines a positive and negative finding for influenza A and influenza B, you should list two units of 87804.

Caution: Some direct optical observation flu tests say they’re for influenza A and B, but report just one finding of positive or negative for flu. The result doesn’t indicate if the finding is for A or B, just that the specimen is positive or negative for either flu strain. In those cases, you should list just one unit of 87804.