Billing and Coding: Influenza Diagnostic Tests
A58817
Molecular testing (RT-PCR or other nucleic acid amplification) is recommended for hospitalized patients with suspected influenza and for confirmation in specific outpatient scenarios; point-of-care testing is encouraged prior to prescribing antibiotics to avoid unnecessary use. Rapid antigen tests may be used when high-performing RIDTs are available and specimens are collected early (within 3–4 days of onset), but RIDT results should be confirmed by RT-PCR in defined situations (low community activity with positive RIDT, high community activity with negative RIDT, or suspected novel influenza after animal exposure). Billing documentation must follow manufacturer instructions and may require claim modifiers (-QW for CLIA-waived tests and possibly -59 for confirmatory PCR), and viral culture is limited by delays that may preclude timely antiviral therapy.
"Use molecular diagnostic methods (e."