<html><head><style>body{font-family:Helvetica,Arial;font-size:13px}</style></head><body style="word-wrap:break-word;line-break:after-white-space"><div id="bloop_customfont" style="font-family:Helvetica,Arial;font-size:13px;color:rgba(0,0,0,1.0);margin:0px;line-height:auto">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:</div><div id="bloop_customfont" style="font-family:Helvetica,Arial;font-size:13px;color:rgba(0,0,0,1.0);margin:0px;line-height:auto"><br></div><div id="bloop_customfont" style="margin:0px">
<ul><li><font color="#ff2600">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.</font></li></ul><p class="MsoNormal" style="font-family:Helvetica,Arial;font-size:13px">BUT ALSO:</p><p class="MsoNormal" style="color:rgb(0,0,0);font-family:Helvetica,Arial;font-size:13px">
</p><ul><li><font color="#ff5700">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.</font> </li></ul><p class="MsoNormal" style="color:rgb(0,0,0);font-family:Helvetica,Arial;font-size:13px">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.</p><p class="MsoNormal">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.</p><p class="MsoNormal">Good luck!</p><p class="MsoNormal"><br></p><p class="MsoNormal">Michele</p><p class="MsoNormal"><span style="font-family:helvetica,arial">-- </span></p></div><div id="bloop_sign_1636648533707858176" class="bloop_sign"><div style="font-family:helvetica,arial;font-size:13px">Michele Dritz<br><br></div></div> <br><p class="airmail_on">On November 10, 2021 at 2:27:41 PM, Michael Chamberlin via Ohioaap-practicemanagers (<a href="mailto:ohioaap-practicemanagers@lists.deltaforce.net">ohioaap-practicemanagers@lists.deltaforce.net</a>) wrote:</p> <blockquote type="cite" class="clean_bq"><span><div><div></div><div>
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<div>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.</div>
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<div>Has anyone else experienced this before? What ICD 10
code do you link with a rapid strep test?</div>
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<div>Mike</div>
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<div dir="ltr" class="gmail_signature" data-smartmail="gmail_signature">
<div dir="ltr">Michael Chamberlin, M.D., FAAP
<div>Pediatric Assoc. of Mt Carmel</div>
<div>4371 Ferguson Dr</div>
<div>Cincinnati, OH 45230</div>
<div>513-752-3650</div>
<div>513-752-3387 (fax)</div>
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