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    Coding for home health services, rapid flu test

    Q : What code do we use when the doctor certifies patient care plans while patients are in home health facilities?

    Renee Stantz
    A: Several codes can be used for these types of services. Which ones are used will depend on the patient's insurance. Medicare and commercial insurance carriers have different sets of codes.

    Table 1
    Medicare allows providers to bill for home health certification and recertification services using the codes listed in Table 1. Remember these other key points when billing these codes:
    • G0180 and G0179 are only billable by the physician who authorizes home healthcare and signs the plan of care.
    • Diagnosis code(s) must match those on the home health plan of care.
    • Place of service is the physician's office (POS 11).
    • These codes do not apply to Medicaid services, durable medical equipment, and outpatient physical therapy.
    • These codes are billed under Medicare Part B, which requires the physician to bill the co-pay.

    Table 2
    Commercial payers do not recognize the Healthcare Common Procedure Coding System codes that Medicare recognizes for home health services. See Table 2 for the home health services codes to be used for patients covered by commercial insurance. These codes should be used for billing of supervision of a patient in a home health agency when the patient is not present. These codes can be used for certification and recertification as G0180 and G0179 are used for Medicare-covered patients.

    Note: These codes are to be billed in monthly time increments. All services provided by a physician for a patient's care during a calendar month should be billed based on the total time spent, 15 to 29 minutes or 30 minutes or more.


    Q : We have received differing advice as to how to bill the rapid flu test (87804). Should we bill this code as one unit or two?

    A: If your office performs one test, using one sample and one device, to yield one analysis identifying a non-specific flu virus (neither A nor B), Type A flu virus only, or Type B flu virus only, then code using 87804 with one unit. Note: If two tests are run sequentially (one for Type A and the other for Type B), then two units should be reported.

    If your office performs one test, using one sample and one device, to yield two separate, distinct results or analyses (including two results in a single analytical chamber) identifying Type A flu virus and Type B flu virus (positive or negative results for both), then code using 87804 with two units or append the 59 modifier to the second line item, as follows:

    87804 –QW
    87804 –QW, –59

    Whether you bill with two units or the 59 modifier will depend on the payer.

    The author is a compliance manager for Baptist Medical Associates in Louisville, Kentucky. Do you have a primary care-related coding question you would like to have our experts answer in this column? Send it to

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