Pediatric Coding Alert

Answer: When your office staff performs a rapid strep test, you should report 87880 (Infectious agent detection by immunoassay with direct optical observation; Streptococcus, group A). The code describes the rapid, in-office test, which a nurse usually performs to determine whether the physician should start a patient on antibiotics before the culture results are available. Use 87880 (direct observation) for all immunologically based commercial Streptococcus group Atesting kits whose interpretation relies on a visual reaction (observed by the naked eye), according to the December 1998 CPT Assistant.

The Clinical Laboratory Improvement Act (CLIA) considers rapid strep tests, such as Abbott Signify Strep A Test and SmithKline ICON Fx Strep A, waived tests. This classification allows offices to perform the tests without a high-level certification.

The laboratory bills for the culture, so you should not report a code for their procedure.

When your office collects a specimen to send to the lab, you may bill private payers for additional mailing and handling charges with 99000 (Handling and/or conveyance of specimen for transfer from the physician's office to a laboratory). Many coding experts recommend billing 99000 for nonroutine shipping costs, such as sending the specimen via messenger service.

But, 99000 isn't reserved solely for mailing expenses. In fact, 99000 may also reflect the work involved in preparing a specimen prior to sending it to lab. "Typical work involved in this preparation may include centrifuging a specimen, separating serum, labeling tubes, packing the specimens for transport, filling out lab forms, and supplying necessary insurance information and other documentation," the October 1999 CPT Assistant states.

Of course, billing doesn't necessarily translate into payment. Medicare considers 99000 a bundled service and makes no payment for it. Some third-party payers may follow the government agency's lead and not cover the service as well.