[Ohioaap-practicemanagers] CareSource denials of rapid strep tests

[Michele Dritz]

Our billing person also had recently told us providers about some
challenges she was running into around coding & reimbursement for
pharyngitis vs strep codes.  I reached out to her about this message & here
are some of her comments:


   - We have not had any problems with denials of procedure code 87880. I
   just double checked our most recent zero pay report for October and there
   were not any on that either. For the most part we submit that procedure
   code with diagnosis code J02.9 or J02.0 (if they test positive for strep).
   My thought is that the practice may not using the QW modifier to indicate
   the test is CLIA waived. If you can, pass that information on and maybe
   that will help them.

BUT ALSO:


   - We did have issues with Anthem denying the office visit (ex: 99213)
   when we used J06.9 (URI) with J02.0 (Streptococcal pharyngitis) because
   J06.9 includes streptococcal upper respiratory infection. I now just drop
   dx code J02.9 (acute pharyngitis, unspecified) if the strep test comes back
   positive and only submit the J02.0 code. To the best of my knowledge, we
   haven't had any problems receiving payment for 87880,QW.

As a provider we’re kind of stuck because our EMR requires us to choose an
ICD-10 code BEFORE we can even sign-off on an order for a nurse to do.  So
I need to call the dx something initially, but then can’t remove that dx
code retroactively after the POC strep shows positive because it’s already
embedded in my note as the dx code associated with my original test order.

It’s annoying to have to do any work around because of these seemingly
nit-picky things, but that’s been her solution that helped address the
issue.

Good luck!


Michele

-- 
Michele Dritz


On November 10, 2021 at 2:27:41 PM, Michael Chamberlin via
Ohioaap-practicemanagers (ohioaap-practicemanagers at lists.deltaforce.net)
wrote:

We are getting denials for rapid antigen strep testing (87880) when using
"acute pharyngitis, unspecified J02.9."  The guidelines say that if viral
pharyngitis is suspected then a rapid strep test should not be done so I
would understand a denial of the claim if "viral pharyngitis" is used.  We
may try using the ICD 10 code for "pain in throat" but it is silly that we
have to guess at what is the appropriate code to use for this.

Has anyone else experienced this before?  What ICD 10 code do you link with
a rapid strep test?

Mike

Michael Chamberlin, M.D., FAAP
Pediatric Assoc. of Mt Carmel
4371 Ferguson Dr
Cincinnati, OH  45230
513-752-3650
513-752-3387 (fax)

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