How To Use CPT Code 87636

CPT 87636 is a code used for the detection of SARS-CoV-2, influenza A, and influenza B through a multiplex amplified nucleic acid probe technique. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 87636.

1. What is CPT 87636?

CPT 87636 is a medical billing code used for the detection and differentiation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), influenza A, and influenza B using a multiplex amplified nucleic acid probe technique. This test is essential for diagnosing patients with overlapping symptoms of COVID-19 and influenza, as it helps clinicians determine the appropriate course of treatment.

2. 87636 CPT code description

The official description of CPT code 87636 is: “Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) and influenza virus types A and B, multiplex amplified probe technique.”

3. Procedure

1. The lab analyst collects a specimen from the patient, typically through a nasal swab, sputum, or respiratory secretions.
2. The specimen is processed, and amplification techniques such as reverse transcription polymerase chain reaction (RT-PCR) are used to increase the number of copies of specific nucleic acid sequences, if present, for SARS-CoV-2, influenza A, and influenza B.
3. The lab analyst assesses the presence of the amplified nucleic acid sequences using nucleic acid probes, which are fabricated single-strand sequences of DNA or RNA that join with the complementary sequence in the specimen through a process called hybridization.
4. The nucleic acid probe includes a label, such as a fluorescent tag, that allows the lab analyst to visualize the hybridization product, thus detecting the presence of target infectious agents in the specimen.

4. Qualifying circumstances

Patients eligible to receive CPT code 87636 services are those presenting with symptoms that may be indicative of COVID-19 or influenza, such as fever, cough, and muscle aches. The test is particularly useful for patients with overlapping symptoms, making it difficult to diagnose the illness without testing. Additionally, patients with known exposure to individuals with confirmed cases of COVID-19 or influenza may also be eligible for this test.

5. When to use CPT code 87636

It is appropriate to bill the 87636 CPT code when a clinician orders the test to determine whether a patient has COVID-19 or influenza based on their symptoms or exposure history. The test is essential for accurate diagnosis and appropriate treatment, especially in cases where symptoms overlap or are difficult to differentiate without testing.

6. Documentation requirements

To support a claim for CPT 87636, the following information should be documented:

• Patient’s demographic information, including name, date of birth, and insurance information.
• Relevant clinical history, including symptoms, exposure history, and any previous testing or treatment for COVID-19 or influenza.
• Ordering clinician’s information, including name, contact details, and National Provider Identifier (NPI) number.
• Details of the specimen collection, including date, time, and method of collection.
• Results of the test, including the presence or absence of SARS-CoV-2, influenza A, and influenza B.
• Interpretation of the test results by the ordering clinician, including any recommended treatment or follow-up care.

7. Billing guidelines

When billing for CPT code 87636, it is essential to follow the specific guidelines and rules set by the payer. Some general tips include:

• Ensure that all required documentation is complete and accurate to support the claim.
• Verify the patient’s insurance coverage and benefits for the test.
• Use the appropriate diagnosis codes to indicate the reason for the test, such as suspected COVID-19 or influenza.
• Submit the claim in a timely manner, adhering to the payer’s submission deadlines.

8. Historical information

CPT 87636 was added to the Current Procedural Terminology system on October 6, 2020. There have been no updates to the code since its addition.

9. Similar codes to CPT 87636

Five similar codes to CPT 87636 include:

1. CPT 87637: This code is used when the test also includes respiratory syncytial virus detection.
2. CPT 87471: The parent code for 87636, used for infectious agent detection by nucleic acid (DNA or RNA).
3. CPT 87502: This code is used for the detection of influenza virus types A and B by nucleic acid (DNA or RNA).
4. CPT 87635: This code is used for the detection of SARS-CoV-2 (COVID-19) by nucleic acid (DNA or RNA).
5. CPT 87804: This code is used for the detection of influenza virus types A and B by immunoassay with direct optical observation.

10. Examples

Here are 10 detailed examples of CPT code 87636 procedures:

1. A patient presents with fever, cough, and body aches, and the clinician orders the test to determine if the patient has COVID-19 or influenza.
2. A patient with a known exposure to a confirmed COVID-19 case presents with mild symptoms, and the clinician orders the test to confirm the diagnosis.
3. A patient with a history of chronic respiratory issues presents with worsening symptoms, and the clinician orders the test to rule out COVID-19 or influenza as the cause.
4. A patient presents with symptoms that could be indicative of either COVID-19 or influenza, and the clinician orders the test to determine the appropriate treatment plan.
5. A patient with a compromised immune system presents with respiratory symptoms, and the clinician orders the test to determine if the patient has COVID-19 or influenza.
6. A patient presents with symptoms that have not improved after receiving treatment for a suspected respiratory infection, and the clinician orders the test to confirm the diagnosis.
7. A patient with a history of recent travel to an area with a high prevalence of COVID-19 presents with respiratory symptoms, and the clinician orders the test to determine if the patient has COVID-19 or influenza.
8. A patient presents with respiratory symptoms during flu season, and the clinician orders the test to differentiate between COVID-19 and influenza.
9. A patient with a history of asthma presents with worsening respiratory symptoms, and the clinician orders the test to rule out COVID-19 or influenza as the cause.
10. A patient presents with respiratory symptoms and a high-risk occupation, such as a healthcare worker, and the clinician orders the test to determine if the patient has COVID-19 or influenza.