How To Use CPT Code 87428

CPT 87428 is a code used for the detection of infectious agent antigens, specifically SARS-CoV, SARS-CoV-2 (COVID-19), and influenza virus types A and B, through immunoassay techniques. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 87428.

1. What is CPT 87428?

CPT 87428 is a code used to represent the detection of infectious agent antigens, specifically severe acute respiratory syndrome coronavirus (SARS-CoV), SARS-CoV-2 (COVID-19), and influenza virus types A and B, through immunoassay techniques. This test helps clinicians distinguish between common viral causes of respiratory illness and is essential in the diagnosis and treatment of patients with these infections.

2. 87428 CPT code description

The official description of CPT code 87428 is: “Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]), qualitative or semiquantitative; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19]) and influenza virus types A and B.”

3. Procedure

The procedure for CPT 87428 involves the following steps:

1. Collection of patient specimen, such as a nasal swab.
2. Swirling the swab in a reagent tube to transfer the analyte to a test cassette.
3. Processing the test cassette in an analyzer that uses immunoassay techniques, such as EIA, ELISA, FIA, or IMCA, to detect target antigens in the sample.
4. Interpretation of the test results as qualitative or semiquantitative to determine the presence of SARS-CoV, SARS-CoV-2, and influenza virus types A and B antigens.

4. Qualifying circumstances

Patients eligible to receive CPT code 87428 services are those who present with symptoms of respiratory illness and require testing to determine if the cause is due to SARS-CoV, SARS-CoV-2, or influenza virus types A and B. This may include patients with fever, cough, shortness of breath, or other respiratory symptoms. Clinicians may also order this test for patients who have been exposed to individuals with confirmed cases of these infections or those who are at high risk for complications due to underlying health conditions.

5. When to use CPT code 87428

It is appropriate to bill the 87428 CPT code when a patient requires testing for the presence of SARS-CoV, SARS-CoV-2, or influenza virus types A and B antigens to help determine the cause of their respiratory illness. This test is particularly useful in distinguishing between these common viral causes of respiratory infections and guiding appropriate treatment and management strategies.

6. Documentation requirements

To support a claim for CPT 87428, the following information should be documented:

• Patient’s demographic information, including name, date of birth, and insurance information.
• Relevant clinical history, including presenting symptoms, exposure history, and risk factors for complications.
• Indication for the test, such as suspected infection with SARS-CoV, SARS-CoV-2, or influenza virus types A and B.
• Details of the specimen collection, including the type of specimen and collection method.
• Test results, including the presence or absence of target antigens and any additional findings.
• Clinician’s interpretation of the test results and any subsequent treatment or management recommendations.

7. Billing guidelines

When billing for CPT code 87428, it is essential to follow the specific guidelines and rules set forth by the payer. Some payers may pay separately for collecting the specimen, while others may bundle the collection with the test itself. Additionally, it is crucial to ensure that all documentation requirements are met to support the claim and avoid potential denials or delays in payment.

8. Historical information

CPT 87428 was added to the Current Procedural Terminology system on November 10, 2020. There have been no updates to the code since its addition.

9. Similar codes to CPT 87428

Five similar codes to CPT 87428 and how they differentiate are:

1. CPT 87301: This code is used for infectious agent antigen detection by immunoassay technique for a single target, rather than multiple targets as in CPT 87428.
2. CPT 87451: This code is used for infectious agent antigen detection by immunoassay with multiple targets other than those listed in CPT 87428.
3. CPT 87426: This code is used for the detection of SARS-CoV and SARS-CoV-2 antigens only, without the inclusion of influenza virus types A and B.
4. CPT 87427: This code is used for the detection of influenza virus types A and B antigens only, without the inclusion of SARS-CoV and SARS-CoV-2.
5. CPT 87502: This code is used for the detection of influenza virus types A and B through nucleic acid amplification techniques, rather than immunoassay techniques as in CPT 87428.

10. Examples

Here are 10 detailed examples of CPT code 87428 procedures:

1. A patient presents to the clinic with fever, cough, and shortness of breath. The clinician suspects a viral respiratory infection and orders CPT 87428 to test for SARS-CoV, SARS-CoV-2, and influenza virus types A and B antigens.
2. A patient with a known exposure to a confirmed COVID-19 case develops respiratory symptoms and is tested using CPT 87428 to determine if they have contracted the virus.
3. An elderly patient with multiple comorbidities presents with respiratory symptoms during flu season. The clinician orders CPT 87428 to test for SARS-CoV, SARS-CoV-2, and influenza virus types A and B antigens to guide appropriate treatment.
4. A patient with a history of asthma presents with worsening respiratory symptoms. The clinician orders CPT 87428 to rule out infection with SARS-CoV, SARS-CoV-2, or influenza virus types A and B as the cause of their symptoms.
5. A healthcare worker with respiratory symptoms is tested using CPT 87428 to determine if they have contracted SARS-CoV, SARS-CoV-2, or influenza virus types A and B and to guide appropriate infection control measures.
6. A patient with a recent travel history to an area with a high prevalence of COVID-19 presents with respiratory symptoms. The clinician orders CPT 87428 to test for SARS-CoV, SARS-CoV-2, and influenza virus types A and B antigens.
7. A patient with a compromised immune system presents with respiratory symptoms. The clinician orders CPT 87428 to test for SARS-CoV, SARS-CoV-2, and influenza virus types A and B antigens to guide appropriate treatment and management strategies.
8. A patient presents with respiratory symptoms during an outbreak of a novel respiratory virus. The clinician orders CPT 87428 to test for SARS-CoV, SARS-CoV-2, and influenza virus types A and B antigens to help determine the cause of their illness.
9. A patient with a history of chronic obstructive pulmonary disease (COPD) presents with worsening respiratory symptoms. The clinician orders CPT 87428 to test for SARS-CoV, SARS-CoV-2, and influenza virus types A and B antigens to guide appropriate treatment.
10. A patient presents with respiratory symptoms and a high fever during a local outbreak of influenza. The clinician orders CPT 87428 to test for SARS-CoV, SARS-CoV-2, and influenza virus types A and B antigens to help determine the cause of their illness.