How To Use CPT Code 87804

CPT 87804 is a code used for the detection of influenza antigens through immunoassay with direct optical observation. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 87804 procedures.

1. What is CPT 87804?

CPT 87804 is a medical billing code used to describe the detection of infectious agent antigens, specifically influenza, through an immunoassay with direct optical (visual) observation. This test is typically performed on a patient sample, such as a throat or nasal swab or nasal washings, to help diagnose patients with influenza A or B virus infections.

2. 87804 CPT code description

The official description of CPT code 87804 is: “Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; Influenza.”

3. Procedure

The 87804 procedure involves the following steps:

1. Collection of a patient sample, typically a throat or nasal swab or nasal washings.
2. Extraction of viral particles from the swab or washings.
3. Incubation of the extraction phase.
4. Adding the extracted liquid to a test device containing antibodies to influenza virus.
5. Observation of a color change, such as a colored line, indicating the presence of flu antigens.
6. Direct visual observation of the reaction by the analyst.

4. Qualifying circumstances

Patients who are eligible to receive CPT code 87804 services are those presenting with symptoms suggestive of an influenza infection, such as fever, chills, muscle pain, and cough. Clinicians may order this test to help rapidly diagnose patients with infection with influenza A or B virus, allowing for appropriate treatment and management of the patient’s condition.

5. When to use CPT code 87804

It is appropriate to bill the 87804 CPT code when a healthcare provider orders an immunoassay test for the detection of influenza antigens in a patient sample, and the test is performed using direct optical observation. This code should be used when the test is specifically for the detection of influenza A or B virus antigens.

6. Documentation requirements

To support a claim for CPT 87804, the following information should be documented:

• Patient’s presenting symptoms and clinical history suggestive of an influenza infection.
• Order for the influenza antigen detection test by the healthcare provider.
• Details of the sample collection, including the type of sample (throat or nasal swab, nasal washings) and the date of collection.
• Results of the immunoassay test, including the presence or absence of influenza antigens and the type of influenza virus (A or B) if detected.
• Direct visual observation of the test reaction by the analyst.

7. Billing guidelines

When billing for CPT code 87804, it is important to follow the appropriate guidelines and rules. Some tips and codes that apply to CPT code 87804 include:

• Ensure that the test is specifically for the detection of influenza A or B virus antigens, as other infectious agent antigen detection tests may have different CPT codes.
• Document all necessary information to support the claim, as outlined in the documentation requirements section.
• Verify that the patient’s insurance plan covers the 87804 CPT code, as coverage may vary between plans.
• Be aware of any applicable modifiers that may need to be added to the CPT code, such as modifier 59 for a distinct procedural service.

8. Historical information

CPT 87804 was added to the Current Procedural Terminology system on January 1, 2002. The code was changed on October 6, 2020, with the previous descriptor being “Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; Influenza.”

9. Similar codes to CPT 87804

There are several other codes related to infectious agent antigen detection that differentiate from CPT 87804. Some of these codes include:

• CPT 87800: Detection of multiple infectious agents through a multiplex method.
• CPT 87801: Detection of multiple infectious agents through a multiplex method with additional targets.
• CPT 87802: Detection of infectious agent antigens through immunoassay with direct optical observation for Streptococcus A.
• CPT 87803: Detection of infectious agent antigens through immunoassay with direct optical observation for Clostridium difficile.
• CPT 87806: Detection of infectious agent antigens through immunoassay with direct optical observation for respiratory syncytial virus.

10. Examples

Here are 10 detailed examples of CPT code 87804 procedures:

1. A patient presents with fever, chills, and cough, and the healthcare provider orders an influenza antigen detection test. The test is performed using a throat swab and direct optical observation, resulting in a positive result for influenza A virus.
2. A patient with a history of chronic obstructive pulmonary disease (COPD) presents with worsening respiratory symptoms and fever. The healthcare provider orders an influenza antigen detection test using a nasal swab and direct optical observation, which detects influenza B virus antigens.
3. An elderly patient presents with muscle pain, fever, and cough during flu season. The healthcare provider orders an influenza antigen detection test using nasal washings and direct optical observation, resulting in a positive result for influenza A virus.
4. A pediatric patient presents with fever, cough, and sore throat. The healthcare provider orders an influenza antigen detection test using a throat swab and direct optical observation, which detects influenza B virus antigens.
5. A patient with a compromised immune system presents with fever, chills, and cough. The healthcare provider orders an influenza antigen detection test using a nasal swab and direct optical observation, resulting in a positive result for influenza A virus.
6. A patient presents with fever, chills, and cough during an influenza outbreak in the community. The healthcare provider orders an influenza antigen detection test using nasal washings and direct optical observation, which detects influenza B virus antigens.
7. A patient with a history of asthma presents with worsening respiratory symptoms and fever. The healthcare provider orders an influenza antigen detection test using a throat swab and direct optical observation, resulting in a positive result for influenza A virus.
8. An adult patient presents with fever, cough, and body aches during flu season. The healthcare provider orders an influenza antigen detection test using a nasal swab and direct optical observation, which detects influenza B virus antigens.
9. A patient presents with fever, chills, and cough after recent travel to an area with a high prevalence of influenza. The healthcare provider orders an influenza antigen detection test using nasal washings and direct optical observation, resulting in a positive result for influenza A virus.
10. A pregnant patient presents with fever, cough, and sore throat. The healthcare provider orders an influenza antigen detection test using a throat swab and direct optical observation, which detects influenza B virus antigens.