CPT code 87880 is a simple yet integral procedure that physicians often perform themselves in their office. However, understanding its nuances is crucial for accurate billing and timely reimbursement.
Thus, this guide will cover everything you need to know about CPT 87880, from a comprehensive overview of its descriptor to real-world clinical scenarios and the essential billing guidelines.
This guide will help you navigate the complexities of clinical lab billing with confidence. Our billing specialists at MediBillMD have penned this guide with a simple goal: to help you ensure that your claims are not only accurate but also fully justified.
So, without further ado, let’s get started!
CPT Code 87880 – Description
CPT code 87880 is from the ‘Infectious Agent Antigen Detection’ code range. It covers an immunoassay with direct optical (visual) observation. This procedure aims to detect Streptococcus (strep for short), group A, in a patient sample, which is typically a throat swab.
Below, we have explained each technical term individually to help you better understand the CPT 87880 descriptor:
Immunoassay
It is the method used for the test. It utilizes some specific antibodies to find and bind to the antigens you are searching for.
With Direct Optical Observation
For the unversed, it is just a fancy way of saying that you can see the result with your naked eyes. That is, you do not need a complex machine or a microscope.
Streptococcus, Group A
It is the specific germ that causes strep throat. The procedure covered under CPT code 87880 aims to detect it.
Scenarios Where CPT Code 87880 is Applicable
The following are some of the real-world clinical scenarios where physicians perform a rapid strep test using a throat swab:
Pediatric Patient with Sore Throat
Picture a 6-year-old girl brought to the urgent care clinic by her parents with a complaint of a high-grade fever, sore throat, and difficulty swallowing.
The pediatrician observes swelling and redness in the throat along with white patches on the tonsils. Thus, he performs a rapid immunoassay test using a throat swab to confirm or rule out bacterial pharyngitis caused by Group A Streptococcus. The visual result came back positive, confirming the diagnosis.
Here, the pediatrician should report J02.0 (Streptococcal pharyngitis) for diagnosis, and CPT code 87880 for the rendered service.
Routine Check-up with Respiratory Symptoms
Assume a 28-year-old male patient who visits his primary care physician for a routine check-up. He complains of experiencing a persistent cough and a mild sore throat without fever for the past couple of days.
Thus, the physician performs a rapid strep test as part of the differential diagnosis since the patient reports non-specific symptoms.
The visual result is negative, which helps the physician confirm that the illness is possibly viral.
Here, the applicable diagnosis and procedure code pair will be JJ06.9 (Acute upper respiratory infection, unspecified) and CPT code 87880.
A Possible Co-Infection
Imagine a 33-year-old female patient who comes to the urgent care clinic with symptoms of a sinus infection. Besides having a sore throat, these include green nasal discharge, congestion, and facial pressure.
The physician performs a rapid strep test using a throat swab. However, the result is negative. Therefore, the physician proceeds with treatment for the presumed sinusitis.
So, the applicable code pair will be J01.90 (Acute sinusitis, unspecified), and CPT code 87880.
Applicable Modifiers for CPT Code 87880
Here, let’s take a look at an applicable modifier for CPT 87880:
Modifier QW
Modifier QW is an integral modifier that you must always append to CPT code 87880 while reporting a rapid strep test using a throat swab. It indicates that the reported service is classified as a CLIA-waived test since it is easy to perform with a low risk of error, making it exempt from most standard regulatory requirements.
CPT Code 87880 – Billing & Reimbursement Guidelines
Discussed below are the essential guidelines for reporting a rapid strep test via throat swab:
Ensure Comprehensive Documentation
Undoubtedly, documentation is one of the most critical aspects of medical billing. If you report a procedural code but do not document why and how you performed it, then it is not considered rendered. It will result in a straight-up claim denial.
Simply put, your chart notes for CPT code 87880 must include a description of the patient’s symptoms, the physical examination, the medical decision-making that led to it, and the visual result of the test.
Establish Medical Necessity
It goes without saying that every service you bill must be medically necessary. The diagnosis code you select is the primary way you communicate this to a payer.
Therefore, the diagnosis code must logically correspond to the procedural code. For instance, reporting CPT code 87880 with a diagnosis of an ankle sprain is inappropriate and results in immediate claim denial.
Some of the justifiable clinical indications for a rapid strep test are listed below:
- Acute onset of a sore throat
- Fever
- Nausea, vomiting, or headache, especially in children
- Painful swallowing
- Tender and swollen lymph nodes in the neck
- Tiny red spots on the roof of the mouth
- Tonsils that appear red, swollen, or have white patches
Understand Payer-Specific Policies
Payer policies significantly vary when billing for different procedures. The Centers for Medicare and Medicaid (CMS) sets the standards for Medicare, but private payers may have their own rules regarding global periods, modifiers, and bundling.
Thus, before filing a claim with CPT code 87880, we advise you to communicate with the relevant payer and adhere to their specific policies.
Summary
You deserve a pat on the back for reading this guide till the end. With that said, it is time to conclude it. However, before we wrap up. Let’s quickly recap the key takeaways:
First, we explained the CPT code 87880 descriptor. It covers a rapid strep test using a throat swab.
Next, we shared a few real-world clinical scenarios. These include possible co-infection, routine check-up with respiratory symptoms, and a pediatric patient with a sore throat.
We also discussed modifier QW that applies to CPT 87880 and indicates that this procedure is a CLIA-waived test.
Finally, we explained the essential billing and reimbursement guidelines.
Hopefully, these details will help you ensure accurate coding and timely reimbursements. However, if you still struggle, feel free to outsource clinical lab billing services to MediBillMD.
