Medical Billing Forum

Coding => Coding => Topic started by: rkillian on March 26, 2009, 01:13:15 PM

Title: Rapid Flu Test
Post by: rkillian on March 26, 2009, 01:13:15 PM
What is the correct cpt code for billing a rapid flu test in the office?
Title: Re: Rapid Flu Test
Post by: Michele on March 26, 2009, 06:26:02 PM
If you are billing for the procedure in which you take a respiratory sample (e.g., throat or nasal swab, nasal aspirate or sputum) and do the rapid test, you should submit 87804, "Infectious agent antigen detection by immunoassay with direct optical observation; Influenza."  However, if you are using some other source (e.g., culture material) or technique, which would not generally be considered a "rapid" flu test, you should submit a different code, such as 87400, "Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple step method; Influenza, A or B, each.

Michele
Title: Re: Rapid Flu Test
Post by: redeyecherry on January 19, 2010, 03:44:29 PM
I have been billing the Rapid flu test with 87804 modifier 59 and 87804 modifier QW, i used URI as diagnosis code but i am not getting paid.
Any suggestions?
Title: Re: Rapid Flu Test
Post by: Michele on January 19, 2010, 08:00:28 PM
What is the denial reason?
Title: Re: Rapid Flu Test
Post by: redeyecherry on January 20, 2010, 09:58:31 AM
"The Providerwas not certified/eiligible to be paid for this procedure/service on this date of service"
Title: Re: Rapid Flu Test
Post by: PMRNC on January 20, 2010, 10:22:03 AM
That's not a denial based on WHAT you billed but rather the eligibility of the provider.
Title: Re: Rapid Flu Test
Post by: Michele on January 20, 2010, 08:29:41 PM
It sounds to me like the provider doesn't have their CLIA waiver on file with Medicare.

Michele
Title: Re: Rapid Flu Test
Post by: redeyecherry on January 22, 2010, 03:49:05 PM
OK thanks :D
i just appealed it with copy of the CLIA certificate - hoping it will finally go through now.
thanks a bunch for all the answers
Title: Re: Rapid Flu Test
Post by: Michele on January 25, 2010, 07:29:09 AM
I'm afraid that won't be enough.  I think they will require that you complete a CMS application with the CLIA waiver info on it.  There is a place in the CMS form to indicate if a provider has a CLIA number.

Michele
Title: Re: Rapid Flu Test
Post by: redeyecherry on January 25, 2010, 11:09:30 AM
ah ok, well we do have the CLIA number in every claim when we send it and it is only medicare that wont pay so i hoped that will help.
Off to calling medicare then

thanks again