By: Dean Viskovich
What options do doctors have in determining if a patient has the flu or COVID-19?
The days of assuming a sniffle and low fever during the Fall are just signs of the common flu are long gone. The challenge doctors now face is determining whether a cough, temperature and sore throat is the flu or COVID-19. If the symptoms are essentially the same for both illnesses, what’s a doctor to do? In the old days before Fall of 2019, a doctor would order a lab test to see if the patient tested positive for the flu. Today, a doctor who is faced (in person or virtually) with a patient with fever, chills, cough, runny nose, headaches and fatigue now must know if it is the seasonal flu or COVID-19. Ordering a COVID-19 test may seem like the obvious choice, but a more efficient alternative exists. Instead of a standalone COVID-19 test, ordering a comprehensive respiratory pathogen panel is a better decision.
Ordering a COVID-19 test and getting a negative result while the patient continues to be symptomatic is cause for uncertainty and concern for both the doctor and patient. Many people are under orders to notify their employer or school as well as quarantine for a period of time, on top of isolating from friends and family. A lab panel that targets multiple pathogens at the same time, including the flu and COVID-19, can provide much needed peace of mind. Finding out that you don’t have COVID-19 but instead have the flu with a single set of lab tests would not only be a relief to the patient, but also to the doctor. Doctors need to be aware of the option to order updated lab panels that include both the flu and COVID-19 test.
There is currently a cost differential for both the patient and doctor for a COVID-19 test vs. a full respiratory pathogen panel. The Clinical Lab Fee Schedule (CLFS) reimburses labs for the COVID-19 PCR test at $100. The respiratory pathogen panel price will vary depending on the number of viruses targeted, but a panel having 3-5 targets is reimbursed at a rate of $142.63. As you increase the number of pathogens targeted, that reimbursement rate climbs higher. With a comprehensive respiratory pathogen panel not only would patients and doctors have better and more complete information about the illness in question, but concerns regarding patient financial responsibility should be reduced. In addition, patients should check with their insurance company as many have waivers regarding coinsurance, copays and deductibles for services provided during the pandemic.
Labs are currently revising their respiratory pathogen panel to add COVID-19, but the practice is not universal. Labs allowing doctors to electronically order a comprehensive respiratory panel that includes both the flu and COVID-19 is an option that should be considered the new normal.
UPDATE:
As a follow up to the article above, the American Medical Association (AMA) has updated its Current Procedural Terminology (CPT) to include laboratory respiratory pathogen tests to include coding for laboratory tests that detect both COVID-19 and influenza at the same time.
CPT Code 87636 tests for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease {COVID-19}) and influenza virus types A and B. CPT Code 87637 tests for SARS-Cov-2, COVID-19, influenza virus types A and B and respiratory syncytial virus. See code info here.
The healthcare provide should check with its laboratory to see if the option to order a more comprehensive respiratory panel that includes testing for both COVID-19 and influenza is currently available.