Pathology/Lab Coding Alert

Question: We're considering starting to use an influenza test kit in our physician office lab, but we would like to know what CPT code we will need to use so we can figure out payment. What code should we use?


Texas Subscriber


Answer: Without more information about the test kit, your question does not have a clear-cut answer. There are many lab tests for influenza, so you'll have to answer the following questions to figure out the code:

1. Does the test detect influenza antigen or antibody?
2. What is the detection method--enzyme immunoassay (EIA), direct fluorescence, or direct optical observation?
3. Does the test specify influenza A or B? Armed with that information, you should be able to select the proper code from the following list:

• 86710--Antibody; influenza virus

• 87275--Infectious agent antigen detection by immunofluorescent technique; influenza B virus

• 87276--... influenza A virus

• 87400--Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple step method; influenza A or B, each

• 87804--Infectious agent antigen detection by immunoassay with direct optical observation; influenza. The lab performs the antibody test (86710) on a blood specimen, but you can perform many of the other tests on specimens such as an upper respiratory swab.

You must pay attention to identification of influenza A or B when you select the code. If your test kit does not differentiate between the two, you cannot use 87275, 87276 or 87400, even if the kit uses one of the methods described.

Notice that you can use 87400 for influenza A or B, and that you should report two units of the code if the lab performs the test for both. Reader Questions and You Be the Coder were prepared with the assistance of R. M. Stainton Jr., MD, president of Doctors' Anatomic Pathology Services in Jonesboro, Ark.