Pathology/Lab – Eliminate the Confusion of Streptoccal Detection Codes
Article by Dpsupercoder
Coding for streptococcal detection methods can be confusing, with multiple references scattered through CPTs immunology and microbiology sections. The deletion of 86588 (streptococcus, screen, direct) in CPT code 87880 but must include the modifier -QW (CLIA waived test) if performed at a CLIA waived-status lab, she continues. The -QW modifier is required for these labs to be reimbursed, otherwise it is assumed that the lab is performing a non-waived test. Methodology Determines Code Besides the direct optical observation tests (87880), CPT points to three other possible codes for use in place of deleted code 86588. Two of these methods also involve antigen detection, says Bonifas. They are 87430 and 87081. Selecting the correct code for billing depends on which test methodology is used. The culture  is commonly used as a back-up to the rapid strep test , says Werner. If a patient presents with a sore throat and beefy red pharynx, many physicians will order two swabs, one for a rapid strep test and one for a culture, if necessary. If the physician office lab conducts the rapid strep test and the findings are positive, the second swab often is discarded and the culture is not carried out. The coding by the physicians office for this scenario would be CPT 87880. In a different scenario, both tests might be sent to an outside laboratory. The physician may order both the rapid strep test  and a culture , to be performed only if the rapid strep test is negative, states Werner. The physician assigns the diagnosis code at the time of collection, and that is the code we use to bill the test. Often, the physician has assigned ICD-9 code 462 (acute pharyngitis), which is used to bill the rapid strep test and/or the culture, depending on which procedures are actually carried out. The final code used in place of deleted code 86588 is 86403. This method is different from the others in that it screens for the presence of an antibody rather than an antigen, states Werner. The test is used for blood samples, to detect antibodies from a current or past streptococcal infection. If a latex-type agglutination test is used to screen for the presence of streptococcus group an antibody, code 86403 should be reported. Other Streptococcus Detection Codes Coders should be aware that there are other lab tests for streptococcus antigen or antibody detection besides the four cross-referenced in CPT to deleted code 86588, advises Werner. These are generally more definitive tests that are not used for a simple strep screen. For example, probe techniques for streptococcus antigen detection are reported using codes 87650 (infectious agent antigen detection by nucleic acid [DNA or RNA]; streptococcus, group A, direct probe), 87651 (streptococcus, group A, amplified probe technique) or 87652 (streptococcus, group A, quantification). These tests provide a higher degree of sensitivity and specificity but are fairly expensive procedures, says Werner. Thats why these methods are not usually used by labs for a low-reimbursement test like strep screening. Another example is a more definitive test for streptococcus antibody detection. We currently use the antistreptolysin 0 (AS0) titer,
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