CPT 87491, cpt code 87491, 87491 cpt code

How To Use CPT 87491 | Chlamydia Detection With Amplified Probe Technique

CPT 87491 is a code used for the detection of Chlamydia trachomatis through nucleic acid amplification techniques. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 87491 procedures.

1. What is CPT 87491?

CPT 87491 is a code used by medical professionals to bill for the laboratory testing of Chlamydia trachomatis using nucleic acid amplification techniques. This test is essential for diagnosing Chlamydia infections, which can lead to serious health complications if left untreated.

2. 87491 CPT code description

The official description of CPT code 87491 is: “Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, amplified probe technique.”

3. Procedure

  1. Collection of the specimen from the patient, typically from the urogenital tract (e.g., penile discharge swab or vaginal swab).
  2. Processing of the specimen in the laboratory.
  3. Amplification of the target nucleic acid sequence using techniques such as polymerase chain reaction (PCR).
  4. Assessment of the presence of Chlamydia trachomatis using a nucleic acid probe through hybridization.
  5. Visualization of the hybridization product using a labeled probe (e.g., radioactive or chemical tag).
  6. Interpretation of the test results by a qualified professional.

4. Qualifying circumstances

Patients eligible to receive CPT code 87491 services are those who are suspected of having a Chlamydia trachomatis infection or are at risk for contracting the infection. This may include individuals who are sexually active, have multiple sexual partners, have a history of sexually transmitted infections (STIs), or are experiencing symptoms consistent with a Chlamydia infection. Additionally, some healthcare providers may routinely test women for Chlamydia trachomatis as part of their standard care.

5. When to use CPT code 87491

It is appropriate to bill the 87491 CPT code when a healthcare provider orders a test for the detection of Chlamydia trachomatis using nucleic acid amplification techniques. This test is typically ordered when a patient presents with symptoms consistent with a Chlamydia infection or when a patient is considered at risk for contracting the infection.

6. Documentation requirements

To support a claim for CPT 87491, the following information should be documented:

  • Patient’s demographic information, including name, date of birth, and insurance information.
  • Relevant medical history, including any previous STIs or risk factors for Chlamydia trachomatis infection.
  • Presenting symptoms and physical examination findings consistent with a Chlamydia infection.
  • Order for the Chlamydia trachomatis test using nucleic acid amplification techniques.
  • Specimen collection and processing information, including the date and time of collection, type of specimen, and laboratory processing details.
  • Test results, including the presence or absence of Chlamydia trachomatis and any relevant interpretations by a qualified professional.
  • Treatment plan, including any prescribed medications or follow-up care.

7. Billing guidelines

When billing for CPT code 87491, it is essential to ensure that the test was medically necessary and ordered by a healthcare provider. Additionally, the documentation should clearly support the claim and include all required information. It is also important to differentiate between CPT codes 87490, 87491, and 87492, which represent direct probe, amplified probe, and quantification tests for Chlamydia trachomatis, respectively. For tests detecting Chlamydia antibodies, use codes 86631 and 86632 instead of 87491.

8. Historical information

CPT 87491 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 87491

Five similar codes to CPT 87491 and how they differentiate are:

  1. CPT 87490: This code is used for the detection of Chlamydia trachomatis using a direct nucleic acid probe technique, rather than an amplified probe technique.
  2. CPT 87492: This code is used for the quantification of Chlamydia trachomatis nucleic acids, rather than the detection of the presence or absence of the infection.
  3. CPT 86631: This code is used for the detection of Chlamydia antibodies, rather than the detection of the infectious agent itself.
  4. CPT 86632: This code is also used for the detection of Chlamydia antibodies, but it is specific to the detection of Chlamydia pneumoniae antibodies.
  5. CPT 87810: This code is used for the detection of Chlamydia trachomatis by direct immunofluorescence, rather than nucleic acid amplification techniques.

10. Examples

Here are 10 detailed examples of CPT code 87491 procedures:

  1. A 25-year-old woman presents with pelvic pain and vaginal discharge. Her healthcare provider orders a Chlamydia trachomatis test using nucleic acid amplification techniques.
  2. A 30-year-old man reports pain during urination and penile discharge. His healthcare provider orders a Chlamydia trachomatis test using nucleic acid amplification techniques.
  3. A 22-year-old woman with a history of multiple sexual partners is tested for Chlamydia trachomatis as part of her routine healthcare screening.
  4. A 28-year-old man with a previous history of STIs is tested for Chlamydia trachomatis using nucleic acid amplification techniques.
  5. A 35-year-old woman undergoing infertility evaluation is tested for Chlamydia trachomatis using nucleic acid amplification techniques.
  6. A 19-year-old woman presents with lower abdominal pain and is tested for Chlamydia trachomatis using nucleic acid amplification techniques.
  7. A 32-year-old man with a new sexual partner is tested for Chlamydia trachomatis using nucleic acid amplification techniques as part of a comprehensive STI screening.
  8. A 27-year-old woman with a history of recurrent pelvic inflammatory disease is tested for Chlamydia trachomatis using nucleic acid amplification techniques.
  9. A 24-year-old man presents with testicular pain and is tested for Chlamydia trachomatis using nucleic acid amplification techniques.
  10. A 29-year-old woman with a history of ectopic pregnancy is tested for Chlamydia trachomatis using nucleic acid amplification techniques.

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