Primary Care Coding Alert

Question: We recently ran a rapid strep test on a patient who came in complaining of a sore throat. The nurse who administered the test used R07.0 in the electronic health record (EHR). The test came back negative, and the doctor documented that the patient had a viral sore throat. How should we bill the strep test — with the R07.0 or with a J02.- code?

Arizona Subscriber

Answer: Typically, you would report R07.0 (Pain in throat) to reflect the patient’s chief complaint in the absence of a more definitive diagnosis from administering a rapid strep test such as 87880 (Infectious agent antigen detection by immunoassay with direct optical observation; Streptococcus, group A).

As the test came back negative for strep, you cannot report J02.0 (Streptococcal pharyngitis). Since the physician determined the patient had a viral sore throat, you’ll need a different diagnosis and one more specific than a symptom to bill for the test. Your provider will need to identify the exact organism before you can arrive at the correct code for the diagnosis. In this scenario, you will most likely use J02.8 (Acute pharyngitis due to other specified organisms) or J04.0 (Acute laryngitis). If you do, you will also need to document the infectious agent with a code from the B95-B97 (Bacterial and viral infectious agents) section of ICD-10.

Coding alert: If your practice has a Clinical Laboratory Improvement Amendment (CLIA) waiver and you perform tests in-house, don’t forget to add modifier -QW (CLIA waived test) to the 87880.