Pulmonology Coding Alert

Question: A patient presents with acute sinusitis and an upper respiratory infection that have resulted from a lingering cold. The pulmonologist wants to run a flu test. What diagnosis codes do I use? Should I report 87804 for the testing?

Wisconsin Subscriber

Answer: You'll code 461.9 (Acute sinusitis, unspecified) for the firstlisted diagnosis, 460 for the second, and 465.9 (Acute upper respiratory infection NOS) for the third. Colds and flu share many symptoms, so it's not easy to tell the difference between them based on symptoms alone. Physicians conduct flu tests usually within the first few days of illness in order to tell if a person has the flu.

When your pulmonologist orders a test on a patient for influenza, don't easily fall into reporting 87804 (Infectious agent antigen detection by immunoassay with direct optical observation; influenza). Base your code choice on the type of test, the method, and what product is used.

When your office uses an A&B influenza test, you should code multiple units of 87804 when appropriate. You should report 87804 per strain tested or per result.

Tip: Code 87804 describes the rapid flu test approved by the FDA requiring Clinical Laboratory Improvement Act (CLIA)-waived status. There are cases when carriers may require you to follow Medicare guidelines and append modifier QW (CLIAwaived test) to 87804.