How To Use CPT Code 87481

CPT 87481 is a code for the detection of Candida species using an amplified nucleic acid probe technique. This article will cover the description, procedure, qualifying circumstances, billing guidelines, documentation requirements, historical information, similar codes, and examples of CPT 87481.

1. What is CPT 87481?

CPT 87481 is a code used to represent a laboratory test for the detection of Candida species using an amplified nucleic acid probe technique. This test is performed to diagnose infections caused by Candida species, which are commonly occurring yeast organisms associated with pathological conditions such as vaginal infections and throat infections (thrush).

2. 87481 CPT code description

The official description of CPT code 87481 is: “Infectious agent detection by nucleic acid (DNA or RNA); Candida species, amplified probe technique.”

3. Procedure

1. The lab analyst collects a specimen from a direct source, such as a vaginal swab or expectorated sputum.
2. The specimen is processed using amplification techniques, such as polymerase chain reaction (PCR), which results in a millionfold increase in the number of copies of a specific target nucleic acid sequence.
3. The lab analyst assesses the presence of the amplified nucleic acid sequences that indicate the presence of Candida species using a nucleic acid probe. This probe is a fabricated single-strand sequence of DNA or RNA that binds with the complementary sequence in the specimen through a process called hybridization.
4. The nucleic acid probe includes a label, such as a radioactive or chemical tag, that allows the lab analyst to visualize the hybridization product.

4. Qualifying circumstances

Patients who are suspected of having an infection caused by Candida species are eligible to receive CPT code 87481 services. Clinicians may order this test to diagnose infections such as vaginal infections and throat infections (thrush). It is important to note that this code is not limited to testing for a specific condition, but rather for the detection of Candida species in general.

5. When to use CPT code 87481

CPT code 87481 should be used when a clinician orders a test for the detection of Candida species using an amplified nucleic acid probe technique. This test is appropriate for diagnosing infections caused by Candida species, such as vaginal infections and throat infections (thrush). It is not appropriate to use this code for tests that detect Candida species antibodies or for Candida skin tests; instead, select 86628 or 86485, respectively.

6. Documentation requirements

To support a claim for CPT 87481, the following information should be documented:

• Patient’s demographic information, including name, date of birth, and gender.
• Relevant clinical history and physical examination findings.
• Indication for the test, such as suspected Candida infection.
• Specimen type and collection method (e.g., vaginal swab or expectorated sputum).
• Results of the test, including the presence or absence of Candida species.
• Interpretation of the test results by the ordering clinician.

7. Billing guidelines

When billing for CPT code 87481, it is important to follow the appropriate billing guidelines and rules. Ensure that the test is medically necessary and supported by the patient’s clinical history and physical examination findings. Additionally, make sure to distinguish between CPT codes 87480, 87481, and 87482 for direct probe, amplified probe, and quantification tests for Candida species, respectively.

8. Historical information

CPT 87481 was added to the Current Procedural Terminology system on January 1, 1998. There have been no updates to the code since its addition.

9. Similar codes to CPT 87481

Five similar codes to CPT 87481 and how they differentiate are:

• CPT 87480: Direct probe technique for Candida species detection, rather than the amplified probe technique used in CPT 87481.
• CPT 87482: Quantification test for Candida species, which measures the amount of Candida species present, as opposed to the detection of presence or absence in CPT 87481.
• CPT 86628: Test for Candida species antibodies, which is different from the nucleic acid probe technique used in CPT 87481.
• CPT 86485: Candida skin test, which is not a laboratory test like CPT 87481 and is used to assess the patient’s immune response to Candida species.
• CPT 87511: Infectious agent detection by nucleic acid (DNA or RNA); Gardnerella vaginalis, amplified probe technique, which is similar to CPT 87481 but tests for Gardnerella vaginalis instead of Candida species.

10. Examples

Here are 10 detailed examples of CPT code 87481 procedures:

1. A 25-year-old female presents with symptoms of a vaginal infection, including itching, burning, and discharge. The clinician orders a test for Candida species using an amplified nucleic acid probe technique. The lab analyst collects a vaginal swab and processes the specimen using PCR.
2. A 35-year-old male presents with a persistent sore throat and white patches on his tongue. The clinician suspects a Candida infection (thrush) and orders a test for Candida species using an amplified nucleic acid probe technique. The lab analyst collects an expectorated sputum sample and processes the specimen using PCR.
3. A 45-year-old female with a history of recurrent vaginal infections presents with symptoms consistent with a Candida infection. The clinician orders a test for Candida species using an amplified nucleic acid probe technique. The lab analyst collects a vaginal swab and processes the specimen using PCR.
4. A 55-year-old male with a history of HIV presents with a persistent sore throat and difficulty swallowing. The clinician suspects a Candida infection (thrush) and orders a test for Candida species using an amplified nucleic acid probe technique. The lab analyst collects an expectorated sputum sample and processes the specimen using PCR.
5. A 65-year-old female with a history of diabetes presents with symptoms of a vaginal infection, including itching, burning, and discharge. The clinician orders a test for Candida species using an amplified nucleic acid probe technique. The lab analyst collects a vaginal swab and processes the specimen using PCR.
6. A 75-year-old male with a history of immunosuppressive therapy presents with a persistent sore throat and white patches on his tongue. The clinician suspects a Candida infection (thrush) and orders a test for Candida species using an amplified nucleic acid probe technique. The lab analyst collects an expectorated sputum sample and processes the specimen using PCR.
7. A 28-year-old female presents with symptoms of a vaginal infection, including itching, burning, and discharge. The clinician orders a test for Candida species using an amplified nucleic acid probe technique. The lab analyst collects a vaginal swab and processes the specimen using PCR.
8. A 38-year-old male presents with a persistent sore throat and white patches on his tongue. The clinician suspects a Candida infection (thrush) and orders a test for Candida species using an amplified nucleic acid probe technique. The lab analyst collects an expectorated sputum sample and processes the specimen using PCR.
9. A 48-year-old female with a history of recurrent vaginal infections presents with symptoms consistent with a Candida infection. The clinician orders a test for Candida species using an amplified nucleic acid probe technique. The lab analyst collects a vaginal swab and processes the specimen using PCR.
10. A 58-year-old male with a history of HIV presents with a persistent sore throat and difficulty swallowing. The clinician suspects a Candida infection (thrush) and orders a test for Candida species using an amplified nucleic acid probe technique. The lab analyst collects an expectorated sputum sample and processes the specimen using PCR.