Using 87804 x 2 might result in denial.
If you’re performing a test that detects the flu via immunoassay in the office, your provider might test for two strains of the virus.
Impact: When you file these claims properly, you’ll be paid for two flu tests rather than one. Read on for a bit of knowledge on making your flu test claims sail through on the first try.
When the provider performs a flu test via immunoassay, code the screening with 87804 (Infectious agent antigen detection by immunoassay with direct optical observation; influenza), says Maggie M. Mac, CPC, CEMC, CHC, CMM, ICCE, president of Maggie Mac-Medical Practice Consulting in Clearwater, Fla.
The 87804 code represents “a testing platform that yields a typically qualitative result by producing a signal on the reaction chamber,” explains Melanie Witt, CPC, COBGC, MA, an independent coding consultant in Guadalupita, N.M.
If the test fits all the parameters put forth in its code descriptor, you should report 87804 for your provider’s flu test.
Remember that 87804 is a CLIA- (Clinical Laboratory Improvement Amendments) waived test, meaning you need to have CLIA certification to perform this flu test.
Further, you must append modifier QW (CLIA-waived test) to each 87804 entry on your claim to indicate your CLIA status. The QW modifier is only required for Medicare payers, but some private payers might also want you to use QW.
For a list of CLIA-waived tests, see www.cms.gov/Regulations-and-Guidance/Legislation/CLIA/downloads/waivetbl.pdf.
Once you’ve determined that your provider performed an 87804 flu test, you’re ready to check if she tested for both strains A and B of the flu.
When your provider performs this test in the office to for both flu strains A and B, you’ll be able to report 87804 twice. In order for the claim to succeed, however, you’ll need help from a modifier to separate the flu tests.
If the provider documents that the test provides two separate results — one for influenza virus A and one for B — it would be appropriate to report two units of code 87804, says Witt.
Mac advises coders to list 87804 on two lines with modifier 59 (Distinct procedural service) appended to the second unit of 87804. This is preferable to reporting the code twice on the same line, in her experience.
Mac reports seeing claims with 87804 x 2 on one line, and the second flu test code was “completely ignored” by the payer. When you test for flu types A and B, “you get better responses with 87804-59 on the second line,” she says.