Medical Billing Forum
Coding => Coding => : rkillian March 26, 2009, 04:13:15 PM
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What is the correct cpt code for billing a rapid flu test in the office?
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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
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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?
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What is the denial reason?
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"The Providerwas not certified/eiligible to be paid for this procedure/service on this date of service"
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That's not a denial based on WHAT you billed but rather the eligibility of the provider.
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It sounds to me like the provider doesn't have their CLIA waiver on file with Medicare.
Michele
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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
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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
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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