Pediatric Coding Alert

Question: Our office has been billing 87804 (flu testing) as a quantity of 1 until recently when I discovered our test is for both strains A&B. I have been billing for this and only changing the quantity and adding notes that it is for both A&B, and the payers have been paying on this. Should I instead use a modifier?

Maryland Subscriber

Answer: You should bill multiple units of 87804 only if the test gives you results on each strain. Apply the "1 Result = 1 Code" rule as follows:

If your in-office test does not identify the influenza strain, bill one unit of 87804 (Infectious agent antigen detection by immunoassay with direct optical observation; influenza). For instance, the Quidel QuickVue Influenza Test picks up only the presence of influenza with a single positive/negative result.

If you use a product that differentiates between influenza A & B, report 87804 twice, optimally with two units. The Quidel QuickVue Influenza A+B Test and the Binax NOW A&B Test Two use a single test device (such as a swab) to test for different strains resulting in two results.

Because you bill per result, not per device, don't automatically code two units of 87804 every time you use a Quidel QuickVue Influenza A+B Test or a Binax NOW A&B Test kit. Clinicians do not always require both tests even if the kit can identify two types of influenza.

For payers that do not recognize two units of 87804 and deny the second charge as a duplicate, use modifier 59 (Distinct procedural service) on the second 87804 entry. This modifier indicates a test for a distinct strain.

-- Information for You Be the Coder and Reader Questions provided by F Tessa Bartels, CPC, CPC-E/M, reimbursement manager for pediatric surgery/craniofacial remodeling at Medical College of Wisconsin in Milwaukee; William Dettwyler, MT-AMT, president of Codus Medicus in Salem, Ore.; and Richard H. Tuck, MD, FAAP, a pediatrician at PrimeCare of Southeastern Ohio in Zanesville.