Therefore, for Medicare and any other payer that utilizes CCI edits, billing for both tests of this reflex testing scheme is not permitted. Coding for CPT® 87880 and 87651 may be permitted by some non-Medicare payers if they do not utilize CCI edits.
The correct code to use for a quick strep test is 87880. This is for infectious agent detection by immunoassay with direct optical observation; Streptococcus group A. The key words here are direct optical observation notes Mark Synovec MD CPT-4 advisor for the American Society of Clinical Pathologists.
The CPT® code modifier 59 is used to identify a distinct procedural service. In the context of influenza immunoassay testing, it supports coding CPT® 87400 once for influenza type A and once for influenza type B.
Some clinicians may desire to use both rapid immunoassay and molecular Strep A testing methods in a reflex testing scheme. This scheme is analogous to reflexing a rapid immunoassay to culture in which the molecular test is used in place of culture.
Infectious agent antigen detection by immunoassayCPT® Code 87880 in section: Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation.
ICD-10 code J02. 0 for Streptococcal pharyngitis is a medical classification as listed by WHO under the range - Diseases of the respiratory system .
The laboratory codes must be reported with modifier -QW to be recognized as a CLIA waived test. 87880-QW, infectious agent antigen detection by immunoassay with direct optical observation; streptococcus, group A.
Influenza due to unidentified influenza virus with other respiratory manifestations. J11. 1 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
ICD-10-CM Code for Influenza due to other identified influenza virus with other respiratory manifestations J10. 1.
J02. 0 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
Throat Culture, ComprehensiveTest Name:Throat Culture, ComprehensiveCPT Code:87070Specimen(s) Type:ThroatAcceptable Container(s):SwabTesting Schedule:24 hours/day, 7 days/week10 more rows
There are three codes for COVID-19 testing: 87635 is designed to detect the COVID-19 virus and effective March 13, 2020, and 86328 and 86769 will be used to identify the presence of antibodies to the COVID-19 virus and are effective April 10, 2020.
Depending on how you get the test done, the price of a strep test varies. Generally, emergency rooms are the most expensive places to go for a strep test, with costs as high or higher than $300, while at-home tests typically cost less than $50.
CPT® code 99213: Established patient office or other outpatient visit, 20-29 minutes.
Use QW for Medicare Patients Remember that 87804 is a Clinical Laboratory Improvement Amendments (CLIA) waived test, meaning you need to have CLIA certification to perform these flu tests. Further, you must append modifier QW CLIA-waived test to each 87804 entry on your claim to indicate your CLIA status.
Throat Culture, ComprehensiveTest Name:Throat Culture, ComprehensiveCPT Code:87070Specimen(s) Type:ThroatAcceptable Container(s):SwabTesting Schedule:24 hours/day, 7 days/week10 more rows
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
Title XVIII of the Social Security Act (SSA) §1833 (e) prohibits Medicare payment for any claim lacking the necessary documentation to process the claim
To avoid the overuse of antibiotics and the potential risk of antibiotic resistance, point of care providers should consider testing patients prior to prescribing treatment for a bacterial or influenza infection. Influenza testing (using molecular methods) is recommended for hospitalized patients with suspected influenza.
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
Title XVIII of the Social Security Act, Section 1833 (e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period..
This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L38916, Respiratory Pathogen Panel Testing.
It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim (s) submitted. The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes: 87428, 87631, 87636, 87637, 0240U, 0241U when used in the outpatient setting as outlined in the related LCD..
All those not listed under the “ICD-10 Codes that Support Medical Necessity” section of this article.
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.