Pediatric Coding Alert

Question: Is there an appropriate "collection code" to report for performing the flu nasal wash to test for the flu virus? A local clinic coder told me that she uses 94640, but I thought that code is for a nebulizer treatment. Could 99211 work, if the chart contains proper documentation to support the code?

Colorado Subscriber

Answer: You may include the flu nasal wash as part of the E/M service. If the encounter did not involve the patient directly seeing a physician, meaning the child just saw a nurse for the flu nasal wash, you could bill 99211 (Office or other outpatient visit for the E/M of an established patient, that may not require the presence of a physician. Usually the presenting symptoms are minimal. Typically, 5 minutes are spent performing or supervising these services) if documentation supports using the code.

But if the child first saw the pediatrician for an E/M service, during which the physician ordered the test, you would include the collection work in the established patient office visit code (99212-99215, Office or other outpatient visit for the E/M of an established patient ...).

The code for performing the test is 87804 (Infectious agent antigen detection by immunoassay with direct optical observation; influenza). If you send the specimen out and a lab runs the test, it bills this code. But the Quidel QuickVue Influenza Test is CLIA-waived, so you could perform this test in the office if you have CLIA-waived status. In this case, insurers that follow Medicare coding guidelines may want you to append modifier QW (CLIA waived test) to 87804.

Some insurers may cover 99000 (Handling and/or conveyance of specimen for transfer from the physician's office to a laboratory) for obtaining, handling and conveying a specimen to the lab. Medicare considers 99000 a bundled service and makes no separate payment for it, but some commercial payers may cover the service.

You are correct that 94640 (Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes [e.g., with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing [IPPB] device]) is for nebulizer treatment and does not reference obtaining a wash for flu virus.