Primary Care Coding Alert

Question: My family physician performed a nasal swab for respiratory syncytial virus (RSV). Should I report 87207 or 87280 for the procedure?

New Jersey Subscriber

Answer: Codes 87207 (Smear, primary source with interpretation; special stain for inclusion bodies or parasites [e.g., malaria, coccidia, microsporidia, trypanosomes, herpes viruses]) and 87280 (Infectious agent antigen detection by immunofluorescent technique; respiratory syncytial virus) are for the laboratory's analysis of the nasal pharyngeal swab test specimen. The Clinical Laboratory Improvement Act doesn't include either microbiology code in the list of in-office waived tests. So, you shouldn't bill for the test unless staff perform the analysis in your office laboratory.

No procedure code exists for taking a nasal-swab specimen. The work involved in taking the swab is part of the E/M service.

You may recoup the cost of obtaining, handling and conveying the specimen to an outside laboratory with 99000 (Handling and/or conveyance of specimen for transfer from the physician's office to a laboratory). If your FP incurs additional transportation costs, such as expedited service, you may bill the specimen handling/
conveyance code. Alternatively, you could report 99000 for specimen preparation.

Medicare considers 99000 a bundled service and makes no separate payment for the code. Some commercial payers may cover the service.