Pathology/Lab Coding Alert

Question: When our lab preforms a strep test from a throat swab for a patient that the ordering physician says has “recurrent strep,” what are the appropriate procedure and diagnosis codes?

Tennessee Subscriber

Answer: The appropriate procedure code will depend on what test your lab performs. A common “quick strep” test is 87880 (Infectious agent antigen detection by immunoassay with direct optical observation; Streptococcus, group A). If your lab operates with a certificate of waiver under the Clinical Laboratory Improvement Amendments (CLIA), you’ll need to be sure to append modifier QW (CLIA waived test) to the code.

On the other hand, the lab might perform a nucleic-acid probe technique to identify Streptococcus antigens in the specimen, and you should select the appropriate code depending on the lab method and group you test for using one of the following codes:

• 87650 — Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group A, direct probe technique
• 87651 — … Streptococcus, group A, amplified probe technique
• 87652 — … Streptococcus, group A, quantification

Group B Streptococcus less often causes “strep throat,” so it’s unlikely your lab would test for that organism in this case. If they did, you may use an appropriate code such as 87653 (…Streptococcus, group B, amplified probe technique).

If the lab cultures the throat swab on selective media to presumptively identify Streptococcus, you should report the screening culture code 87081 (Culture, presumptive, pathogenic organisms, screening only).

Because the ordering physician indicates that the patient has had recurrent “strep throat,” the proper diagnosis code for a positive strep test from a throat swab would be J03.01 (Acute recurrent streptococcal tonsillitis). Compare this to the less-specific ICD-10 code, J03.00 (Acute streptococcal tonsillitis, unspecified).