How To Use CPT Code 87631

CPT 87631 refers to the detection of infectious agents in respiratory viruses using nucleic acid techniques. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 87631.

1. What is CPT 87631?

CPT 87631 is a medical procedure code used to describe the detection of infectious agents in respiratory viruses using nucleic acid (DNA or RNA) techniques. This code is specifically used for the detection of three to five types or subtypes of respiratory pathogens, such as adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, and rhinovirus.

2. 87631 CPT code description

The official description of CPT code 87631 is: “Infectious agent detection by nucleic acid (DNA or RNA); respiratory virus (eg, adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 3-5 targets.”

3. Procedure

The 87631 procedure involves the following steps:

1. Collection of a respiratory sample from the patient.
2. Extraction of nucleic acids (DNA or RNA) from the sample.
3. Performing multiplex reverse transcription, if necessary, to convert RNA into complementary DNA (cDNA).
4. Amplification of the target nucleic acids using multiplex amplified probe techniques, such as polymerase chain reaction (PCR).
5. Detection and identification of three to five types or subtypes of respiratory pathogens in the sample.
6. Interpretation of the test results and reporting to the healthcare provider.

4. Qualifying circumstances

Patients eligible to receive CPT code 87631 services are those who present with symptoms of respiratory infections or are suspected of having a respiratory viral infection. This may include patients with fever, cough, shortness of breath, or other respiratory symptoms. The test may also be used for patients who have been exposed to individuals with confirmed respiratory viral infections or during outbreaks of respiratory illnesses in a community or healthcare setting.

5. When to use CPT code 87631

It is appropriate to bill the 87631 CPT code when a healthcare provider orders a test to detect and identify three to five types or subtypes of respiratory pathogens in a patient’s sample using nucleic acid techniques. This code should be used when the test is performed for diagnostic purposes, to guide treatment decisions, or for epidemiological investigations during outbreaks of respiratory illnesses.

6. Documentation requirements

To support a claim for CPT 87631, the following information should be documented:

• Patient’s demographic information, including name, date of birth, and medical record number.
• Date and time of sample collection.
• Type of respiratory sample collected (e.g., nasopharyngeal swab, sputum).
• Clinical indications for the test, such as patient’s symptoms, exposure history, or outbreak investigation.
• Specific respiratory pathogens tested for (e.g., adenovirus, influenza virus, coronavirus).
• Test results, including the presence or absence of each target pathogen.
• Interpretation of the test results and any relevant clinical recommendations.
• Signature of the healthcare provider who ordered the test and the laboratory professional who performed the test.

7. Billing guidelines

When billing for CPT code 87631, it is important to follow the appropriate billing guidelines and rules. Ensure that the test is medically necessary and ordered by a healthcare provider for a patient with qualifying circumstances. Do not bill separately for reverse transcription or other components of the test, as they are included in the code description. Use the appropriate modifiers, if necessary, to indicate any special circumstances related to the test. Always verify the specific billing requirements and reimbursement policies of the payer before submitting a claim.

8. Historical information

CPT 87631 was added to the Current Procedural Terminology system on January 1, 2013. The code was changed on January 1, 2015, with the previous descriptor being “Infectious agent detection by nucleic acid (DNA or RNA); respiratory virus (eg, adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus), multiplex reverse transcription and amplified probe technique, multiple types or subtypes, 3-5 targets.”

9. Similar codes to CPT 87631

Five similar codes to CPT 87631 differentiate as follows:

• CPT 87632 is used for the detection of six to eleven types or subtypes of respiratory pathogens.
• CPT 87633 is used for the detection of twelve to twenty-five types or subtypes of respiratory pathogens.
• CPT 87517 is used for the detection of infectious agents in hepatitis C virus using nucleic acid techniques.
• CPT 87521 is used for the detection of infectious agents in hepatitis B virus using nucleic acid techniques.
• CPT 87522 is used for the detection of infectious agents in hepatitis C virus using nucleic acid techniques and quantification.

10. Examples

Here are 10 detailed examples of CPT code 87631 procedures:

1. A patient presents with fever, cough, and shortness of breath, and the healthcare provider orders a test to detect and identify three respiratory pathogens: influenza A virus, influenza B virus, and respiratory syncytial virus.
2. A patient with a history of exposure to a confirmed case of COVID-19 is tested for the presence of SARS-CoV-2, influenza A virus, and influenza B virus.
3. During an outbreak of respiratory illnesses in a long-term care facility, residents are tested for adenovirus, parainfluenza virus, and respiratory syncytial virus.
4. A patient with asthma presents with worsening respiratory symptoms, and the healthcare provider orders a test to detect rhinovirus, coronavirus, and metapneumovirus.
5. A patient with chronic obstructive pulmonary disease (COPD) is hospitalized with an acute exacerbation, and the healthcare provider orders a test to detect influenza A virus, influenza B virus, and respiratory syncytial virus.
6. A patient with a compromised immune system presents with respiratory symptoms, and the healthcare provider orders a test to detect adenovirus, parainfluenza virus, and respiratory syncytial virus.
7. A patient with a history of travel to an area with a high prevalence of respiratory illnesses is tested for influenza A virus, influenza B virus, and SARS-CoV-2.
8. A healthcare worker with respiratory symptoms is tested for SARS-CoV-2, influenza A virus, and influenza B virus as part of an occupational health screening.
9. A patient with pneumonia is tested for the presence of three respiratory pathogens: adenovirus, parainfluenza virus, and respiratory syncytial virus.
10. A child with a high fever and respiratory symptoms is tested for influenza A virus, influenza B virus, and respiratory syncytial virus to guide treatment decisions.