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Pulmonology Coding Alert

Reader Question:

Correct Use of Modifiers Improves Reimbursements

Published on Mon Mar 26, 2012

Question: Our pulmonologist recently performed two tests for influenza A and B using a test sample and differentiating test kit. We reported the procedure with 87804 x 2. We got paid for only one unit of 87804 and the other test was rejected. Are we wrong in our claim for the second test?Indiana SubscriberAnswer: You are not wrong in your claims for two units of 87804 (Infectious agent antigen detection by immunoassay with direct optical observation; Influenza) as two different and distinct analyses for each influenza type was conducted. However, a majority of the insurance carriers will not pay for the second test indicating that the second test is considered to be duplicative.However, in order to distinguish the second test as a distinct test, you can append modifier 59 (Distinct procedural service) to the second test. This could be a way out to get paid for both the tests. So, [...]
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