Reviewed on April 23, 2015
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Latest on CPT Code 87880 for Rapid Strep Test from Codify's Pediatric Coder
Rapid strep test: A throat culture test to check whether the patient has Group A Streptococcus.
Streptococcus: A bacterium commonly found on the skin or in the throat that can cause a range of infections, from a mildly sore throat or skin infection to potentially life-threatening disease
Tips: Code 87880 represents a test for Group A Streptococcus, often known as a "rapid" strep test. These tests can produce results within minutes to hours, depending on the actual test administered. A rapid strep test can only detect the presence of...
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Quick strep tests those done in the office by most pediatricians are often miscoded. Also, there have been some changes in recent years in strep test codes, so some practices may be using outdated codes. In fact, there are so many different codes for strep tests in CPT that its easy to get confused about which one to use. Jaleh Shaheedy office manager for M. Shaheedy MD of Van Nuys CA writes to say that she is using five different codes. These codes hardly pay for the price of the supply that we buy to do the test Shaheedy notes.
The correct code to use for a quick strep test is 87880. This is for infectious agent detection by immunoassay with direct optical observation; Streptococcus group A. The key words here are direct optical observation notes Mark Synovec MD CPT-4 advisor for the American Society of Clinical Pathologists. Using the code definitions if you are using a kit that requires direct opticali.e. visualobservation to determine if the Strep A antigen is positive then code 87880 is appropriate says Synovec. If it is still an immunoassay but you dont visualize the reaction directlysuch as with instrumentationthen 87430 is most appropriate. However most pediatricians do the rapid test and should be using 87880.
Further clarification of strep test coding comes from the American Medical Association which has received a number of queries regarding these codes. In the December issue of CPT Assistant the AMA comments that 87880 should be used for all immunologically based commercial Streptococcus Group A testing kits whose interpretation rely on a visual reaction observed by the naked eye.
87449 Is Incorrect Coding
One incorrect code that has commonly been used for the rapid strep test is 87449 (Infectious agent antigen detection by enzyme immunoassay technique qualitative or semiquantitative; multiple step method, not otherwise specified, each organism). Another commonly used incorrect code for strep tests is 86403 (Particle agglutination; screen, each antibody).
Code 86558 is not a valid code
Educating Payers
Check the list of tests granted waived status under the Clinical Laboratory Improvement Amendments (CLIA), available at www.cms.gov/Regulations-and Guidance/Legislation/CLIA/Categorization_of_Tests.html. You’ll find a long list of tests reported using 87880-QW (CLIA-waived test). Modifier QW indicates you’re reporting a test given waived status under CLIA. To perform waived tests, a lab doesn't need to meet the requirements mandated for more complicated tests, but the lab does need a CLIA certificate of waiver. Not all payers accept QW, so check you particular payer’s policy.
Naturally if you are using the wrong code you may have a hard time getting reimbursed. If you are using the correct code your problem might be that you just need to educate the insurance companies explains Debbie Karrer billing manager for Agoura West Valley Pediatric Medical Group an eight-pediatrician practice in Agoura CA. A lot of HMOs capitate you on the labs says Karrer. But the rapid strep test isnt done in a lab its done in your office. For an adult its okay to wait two days for a test to be done in a lab the billing manager notes. But for a child its better to get the results right away so you can begin treatment.
The first thing to do is to get the insurance company to understand that 87880 is not being sent out to a lab. Karrer has a simple way of doing this: she has a letter from BioStar the company which makes the strep test her practice uses and she sends a copy to the insurance companies. The letter specifically refers to CPT Codes for BioStars Optimal ImmunoAssay (Strep A OIA).
The BioStar letter which focuses on the need to use code 87880 even discusses reimbursement. The amount you will be reimbursed is determined by the third-party payer the letter says. Generally these payers use as a guideline the reimbursement that has been established by CMS for Medicare enrollees. This amount varies the letter notes but is generally similar to the old strep code (86313) and is three to six dollars greater than 86588 (streptococcus screen direct).
If I get a rejection or too little reimbursement I send that letter along with the rebilling and I usually get paid more on it says Karrer.
Subscriber benefit: To receive a faxed copy of the BioStar letter call 800/508-2582 and ask for document #PCA-9901.
What if you are working under capitation? The ultimate solutionand one that Karrer has worked out with several HMOsis to carve out the strep tests done in the office. Now they pay our cost for the tests plus a certain amount over that says Karrer. It may not be as high as the fee schedule but its still a lot better than keeping it under capitation along with the laboratory tests.
Tip: Some HMOs will pay separately for strep tests if they are marked Stat. This is the system recommended by the provider relations representatives. The purpose we hear is actually to help distinguish between pediatric and adult specimens.""
