ED Coding & Reimbursement Alert - 2011 Issue 6
Influenza: 87804: Avoid Denials for Second-Strain Flu Testing
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Article Overview
This Find-A-Code article reviews coding considerations for influenza rapid testing when results involve more than one strain and when payers apply different claim-processing rules. It is aimed at practices, coders, and billers who need to understand how Medicare Administrative Contractor policies, CLIA-waived reporting, and payer edits can affect claim submission for influenza lab testing. The article also references guidance from CPT Assistant and discusses general approaches used when a second test entry is denied or treated as a duplicate.
Why This Topic Matters
Influenza testing claims can be denied or delayed if the reported test format, payer policy, or modifier usage does not align with carrier expectations. Understanding the article helps coding and billing staff reduce avoidable denials and apply payer-specific laboratory billing guidance more consistently.
Article Sections
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Initial payer considerations
Introduces the claim-processing issue and the role of payer policy in reporting influenza testing when more than one result is involved.
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Report 87804-QW for Optical Analysis
Covers CLIA-waived reporting considerations for the influenza rapid test and the general context in which optical identification is discussed.
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Apply 87804 Coding Rule to When Testing for Strains A and B
Discusses how the article frames billing when influenza testing yields separate strain-related results and how documentation affects reporting.
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Consider This Alternative for 87804 Denial
Addresses payer denial scenarios, alternate claim handling, and the general laboratory-testing guidance referenced later in the article.
What You Will Learn
- How the article frames influenza rapid testing claims when multiple strain results are involved
- What general payer and MAC policy considerations are highlighted for laboratory claim submission
- How CLIA-waived reporting is discussed in relation to influenza testing
- What broad types of modifier and duplicate-claim issues are covered by the article
- How the article relates payer practice to guidance referenced from CPT Assistant
Who Should Read This
- Medical coders
- Billing staff
- Practice managers
- Laboratory billing personnel
- Physician office staff
Codes Discussed
Modifiers Discussed
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