How To Use CPT Code 87507

CPT 87507 refers to a lab test for detecting 12 to 25 types or subtypes of gastrointestinal pathogens using nucleic acid detection techniques. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 87507.

1. What is CPT 87507?

CPT 87507 is a code used for billing a specific laboratory test that detects 12 to 25 types or subtypes of gastrointestinal pathogens. The test utilizes nucleic acid detection techniques, which may include multiplex reverse transcription and multiplex amplified probe technique. This code is used by medical professionals to bill for the services provided during this laboratory test.

2. 87507 CPT code description

The official description of CPT code 87507 is: “Infectious agent detection by nucleic acid (DNA or RNA); gastrointestinal pathogen (eg, Clostridium difficile, E. coli, Salmonella, Shigella, norovirus, Giardia), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 12-25 targets.”

3. Procedure

The procedure for CPT 87507 involves the following steps:

1. Collection of a patient’s sample, such as stool or rectal swab, for testing.
2. Extraction of nucleic acids (DNA or RNA) from the sample.
3. Amplification of the nucleic acids using multiplex amplified probe technique, which may include polymerase chain reaction (PCR) or other methods.
4. Performing multiplex reverse transcription, if necessary, to convert RNA into DNA for further analysis.
5. Detection and identification of 12 to 25 types or subtypes of gastrointestinal pathogens present in the sample.
6. Quantification of the detected pathogens, if required, to assess treatment response or monitor disease progression.
7. Reporting the results to the ordering healthcare provider.

4. Qualifying circumstances

Patients eligible to receive CPT 87507 services are those who:

• Present with symptoms of gastrointestinal infection, such as diarrhea, abdominal pain, fever, or vomiting.
• Have a history of exposure to a known gastrointestinal pathogen or contaminated food or water source.
• Are undergoing treatment for a gastrointestinal infection and require monitoring of treatment response or disease progression.
• Are part of an outbreak investigation or surveillance program for gastrointestinal pathogens.

5. When to use CPT code 87507

It is appropriate to bill CPT 87507 when a healthcare provider orders a laboratory test to detect 12 to 25 types or subtypes of gastrointestinal pathogens using nucleic acid detection techniques. This may be done for diagnostic purposes, treatment monitoring, or as part of an outbreak investigation or surveillance program.

6. Documentation requirements

To support a claim for CPT 87507, the following information should be documented:

• Patient’s demographic information, including name, date of birth, and medical record number.
• Relevant clinical history, such as symptoms, exposure history, and treatment history.
• Indication for the test, including the suspected or confirmed gastrointestinal pathogen(s).
• Details of the sample collection, including date, time, and type of sample (e.g., stool or rectal swab).
• Results of the test, including the detected pathogens and their quantification, if applicable.
• Interpretation of the results by the laboratory professional, including any recommendations for further testing or treatment.
• Communication of the results to the ordering healthcare provider.

7. Billing guidelines

When billing for CPT 87507, keep in mind the following guidelines and rules:

• Ensure that the test is medically necessary and ordered by a healthcare provider for a qualifying patient.
• Document all required information to support the claim, as outlined in the documentation requirements section.
• Do not bill separately for multiplex reverse transcription, as it is included in the CPT 87507 code when performed.
• Use the appropriate CPT code for the number of targets tested, such as CPT 87505 for 3-5 targets or CPT 87506 for 6-11 targets.

8. Historical information

CPT 87507 was added to the Current Procedural Terminology system on January 1, 2015. There have been no updates to the code since its addition.

9. Similar codes to CPT 87507

Five similar codes to CPT 87507 and how they differ are:

1. CPT 87505: This code is used for the detection of 3-5 types or subtypes of gastrointestinal pathogens using the same techniques as CPT 87507.
2. CPT 87506: This code is used for the detection of 6-11 types or subtypes of gastrointestinal pathogens using the same techniques as CPT 87507.
3. CPT 87493: This code is used for the detection of Clostridium difficile toxin gene(s) using nucleic acid amplification techniques.
4. CPT 87497: This code is used for the detection of norovirus using nucleic acid amplification techniques.
5. CPT 87529: This code is used for the detection of herpes simplex virus (HSV) using nucleic acid amplification techniques.

10. Examples

Here are 10 detailed examples of CPT 87507 procedures:

1. A patient presents with severe diarrhea and a history of recent travel to a region with a high prevalence of gastrointestinal infections. The healthcare provider orders a CPT 87507 test to detect potential pathogens.
2. A patient with a history of recurrent Clostridium difficile infection is undergoing treatment and requires monitoring of treatment response. The healthcare provider orders a CPT 87507 test to quantify the pathogen levels.
3. An outbreak of gastrointestinal illness occurs in a long-term care facility. The healthcare provider orders CPT 87507 tests for multiple residents to identify the causative pathogen(s) and guide infection control measures.
4. A patient presents with symptoms of gastrointestinal infection after consuming food from a restaurant with a recent history of foodborne illness. The healthcare provider orders a CPT 87507 test to detect potential pathogens.
5. A patient with a weakened immune system presents with symptoms of gastrointestinal infection. The healthcare provider orders a CPT 87507 test to identify the causative pathogen(s) and guide treatment decisions.
6. A patient with a history of inflammatory bowel disease presents with worsening gastrointestinal symptoms. The healthcare provider orders a CPT 87507 test to rule out an infectious cause.
7. A patient presents with symptoms of gastrointestinal infection after exposure to contaminated water during recreational activities. The healthcare provider orders a CPT 87507 test to detect potential pathogens.
8. A patient with a history of antibiotic use presents with symptoms of gastrointestinal infection. The healthcare provider orders a CPT 87507 test to identify potential antibiotic-resistant pathogens.
9. A patient presents with symptoms of gastrointestinal infection after close contact with an individual diagnosed with a gastrointestinal pathogen. The healthcare provider orders a CPT 87507 test to detect potential pathogens.
10. A patient with a history of gastrointestinal infection requires follow-up testing to confirm pathogen clearance. The healthcare provider orders a CPT 87507 test to detect any remaining pathogens.