Pediatric Coding Alert

Question: A nurse tests a patient for both influenza A and B. She uses testing that involves one sample, one differentiating test kit, and yields two results that are positive or negative each for type A and B. Can I report both tests? Georgia Subscriber

Answer: Yes, since you are performing distinct analyses that yield a test result for each influenza type, you should report two units of 87804 (Infectious agent antigen detection by immunoassay with direct optical observation; influenza). The trick is researching your major insurers' preferences on reporting the second test. Here are three possibilities:

You could report 87804 x 2 to indicate two units of the test. Most insurers, however, will deny the second test as duplicative.

The most appropriate modifier to use is for separate results of rapid flu test A and B is modifier 59 (Distinct procedural service), according to CPT Assistant, May 2009. Reporting 87804, 87804-59 indicates a second distinct test was performed. On the other hand, insurers including BlueCross/ BlueShield (BC/BS) and UnitedHealthcare (UHC) want practices to use modifier 76 (Repeat procedure by the same physician) to report multiple, distinct flu tests.

Best bet: Get your payers' policies in writing or in an email communication and then follow their requirements.