Description of CPT code 87804
This test may be requested as a rapid antigen test for influenza. A highly contagious, acute viral infection of the respiratory tract, influenza is caused by a single-strand RNA virus known as an influenza virus. Sample is respiratory secretion, such as nasal aspirate, a nasopharyngeal or throat swab, or sputum sample; detection is by immunoassay with direct optical (i.e., visual) observation. When referring to primary source infectious disease codes, direct optical observation is a testing platform that produces a signal, such as a colored band, on the reaction chamber that can be interpreted visually.
Various tests may be utilized consisting of one sample, one analysis, and one strip. Depending on the test, the result may be non-differentiating, identifying whether the patient has influenza virus infection but not providing the specificity of influenza A or B; a positive or negative result that is specific only to influenza virus type A; or a positive or negative result that is specific only to influenza virus type B. Below is the CPT code 87804 code description used for Influenza immunoassay.
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87804 Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; Streptococcus, group B Influenza
There are various rapid testing methods for influenza virus types A and B. Therefore, this article provides an overview for reporting the different rapid testing methods for influenza virus types A and B by direct optical observation. Other influenza tests, such as influenza antibody (CPT code 86710), influenza A and B antigen by immunofluorescence (CPT codes 87276 and 87275), and influenza A or B antibody (CPT code 86710) by multi-step enzyme antigen immunoassay (EIA) (CPT code 87400), also describe influenza testing. These different testing systems involve an array of analytic platforms that can either:
1) test for an antibody response to influenza infection (code 86710);
2) identify the influenza antigen using an antibody labeled with fluorophores (codes 87275 and 87276); or
3) use enzyme-linked antibodies to identify influenza antigen in a multistep platform (code 87400).
The immunoassay is used to detect antigen from influenza virus A or B in respiratory secretions (eg, throat swab, nasopharyngeal swab, nasal aspirate, or sputum) from patients experiencing influenza-like illness. Differentiating infections due to influenza A or B from those due to other viruses and bacteria is critical for optimal treatment.
Whether to report one or two units of CPT code 87804, Infectious agent antigen detection by immunoassay with direct optical observation; influenza, varies according to the type of rapid testing method used distinguishing influenza A from influenza B. The rapid detection of influenza virus types A and B may be part of two entirely separate procedures or may be included within the same test device. If the assays provide two separate results (ie, a result for influenza virus A and a result for influenza virus B), it would be appropriate to report two units of code 87804. When two units of code 87804 are submitted, modifier 59, Distinct Procedural Service, may be used to indicate that the two results represent separate services (codes 87804 and 87804-59). Presumptive identification of microorganisms is defined as identification by colony morphology, growth on selective media, Gram stains, or up to three tests (eg, catalase, oxidase, indole, urease). Definitive identification of microorganisms is defined as an identification to the genus or species level that requires additional tests (eg, biochemical panels, slide cultures). If additional studies involve molecular probes, nucleic acid sequencing, chromatography, or immunologic techniques, these should be separately coded using 87140-87158, in addition to definitive identification codes. The molecular diagnostic codes (eg, 81161, 81200-81408) are not to be used in combination with or instead of the procedures represented by 87140-87158. For multiple specimens/sites use modifier 59. For repeat laboratory tests performed on the same day, use modifier 91. Lab Fees for CPT code 87804
| Modifier | Payment Rate | Pricing Indicator |
|---|
| N/A | $16.55 | National |
| QW | $16.55 | National |
PC/TC Indicator (26):9 = Not Applicable
Multiple Procedures (51):9 = Concept does not apply
Bilateral Surgery (50):9 = Concept does not apply
Physician Supervision:09 = Concept does not apply
Assistant Surgeon (80,82):9 = Concept does not apply
Co-Surgeons (62):9 = Concept does not apply
Team Surgery (66):9 = Concept does not apply
Diagnostic Imaging Family:99 = Concept does not apply
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