Pathology/Lab Coding Alert

Question: You stated in last month’s newsletter that the lab should not report two units of 87804 for influenza A and B testing unless the lab performs different test procedures for the different strains. We use a test where we input one specimen, and our analyzer reports a positive/negative result for A, and a positive/negative result for B based on two, separate, internal tests. Can we report two units of 87804?

Washington Subscriber

Answer: The article you mention, “Master Lab Codes for Flu Tests With These 3 Tips” in Pathology/Lab Coding Alert Vol. 20, No. 4 states the Correct Coding Initiative (CCI) instruction that you may “report more than one unit of service (UOS) for testing different strains or species of an organism if and only if different test procedures are performed for the different strains or species. [You] shall not report more UOS than the number of independent test procedures performed.”

If you can document that the lab procedure you’re using involves two, independent, internal tests, you should be able to separately bill each.

CPT^® Assistant May 2006, Vol. 19, Issue 5 describes a scenario such as you’ve described, and gives a coding recommendation, as follows:

One “method of testing uses one sample, one device, and two separate analyses (ie, separate analytical chambers), and yields two separate results that are positive or negative each for influenza virus type A or B … Code 87804 is reported twice because two separate, distinct analyses are performed, providing two separate test results, one for influenza virus A and one for influenza virus B, even if it was one test kit.”

Modifier: Many payers will accept two units of 87804 only if you report the second unit with an appropriate modifier such as 59 (Distinct procedural service).