How To Use CPT Code 87637

CPT 87637 is a code used for the detection of SARS-CoV-2, influenza A, influenza B, and respiratory syncytial virus (RSV) using a multiplex amplified nucleic acid probe technique. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 87637 procedures.

1. What is CPT 87637?

CPT 87637 is a code used to describe the detection and differentiation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), influenza A, influenza B, and respiratory syncytial virus (RSV) using a multiplex amplified nucleic acid probe technique. This test is typically ordered by clinicians to determine whether a patient has influenza, RSV, or COVID-19, as these illnesses may cause overlapping symptoms, making diagnosis difficult without testing.

2. 87637 CPT code description

The official description of CPT code 87637 is: “Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]), influenza virus types A and B, and respiratory syncytial virus, multiplex amplified probe technique.”

3. Procedure

The 87637 procedure involves the following steps:

1. Collection of a specimen from a source such as a nasal swab, sputum, or respiratory secretions.
2. Processing of the specimen by the lab analyst.
3. Amplification of specific nucleic acid sequences, if present, for four viral targets: SARS-CoV-2, influenza A, influenza B, and RSV using techniques such as reverse transcription polymerase chain reaction (RT-PCR).
4. Assessment of the presence of the amplified nucleic acid sequences using nucleic acid probes, which are fabricated single-strand sequences of DNA or RNA used to join with the complementary sequence in the specimen through a process called hybridization.
5. Visualization of the hybridization product using a label, such as a fluorescent tag, to detect the presence of target infectious agent(s) in the specimen.

4. Qualifying circumstances

Patients who are eligible to receive CPT code 87637 services are those presenting with symptoms consistent with influenza, RSV, or COVID-19, such as fever, cough, and muscle aches. Additionally, patients who have been exposed to individuals with confirmed cases of these illnesses or who are at high risk for complications due to underlying health conditions may also qualify for this test.

5. When to use CPT code 87637

It is appropriate to bill the 87637 CPT code when a clinician orders a test to determine whether a patient has influenza, RSV, or COVID-19, and the lab analyst performs the technical steps to detect and differentiate the four viral targets using a multiplex amplified nucleic acid probe technique.

6. Documentation requirements

To support a claim for CPT 87637, the following information should be documented:

• Patient’s demographic information, including name, date of birth, and insurance information.
• Relevant clinical history, including presenting symptoms, exposure history, and risk factors for complications.
• Ordering clinician’s information, including name, contact details, and National Provider Identifier (NPI) number.
• Specimen collection date, time, and method.
• Details of the lab analyst performing the test, including name, contact details, and NPI number.
• Results of the test, including the presence or absence of each viral target.

7. Billing guidelines

When billing for CPT code 87637, it is essential to follow the appropriate guidelines and rules. Ensure that the patient meets the qualifying circumstances for the test, and that all necessary documentation is provided to support the claim. Additionally, be aware of any payer-specific requirements or restrictions related to billing for this code.

8. Historical information

CPT 87637 was added to the Current Procedural Terminology system on October 6, 2020. There have been no updates to this code since its addition.

9. Similar codes to CPT 87637

Five similar codes to CPT 87637 and how they differentiate from CPT 87637 are:

1. CPT 87636: This code is used for the detection of SARS-CoV-2, influenza A, and influenza B, but does not include RSV.
2. CPT 87631, 87632, 87633: These codes are used for the detection of multiple respiratory infectious agents, not including SARS-CoV-2.
3. CPT 87913: This code is used for infectious agent genotype analysis by nucleic acid for SARS-CoV-2, specifically for mutation identification in targeted regions.

10. Examples

Here are 10 detailed examples of CPT code 87637 procedures:

1. A patient presents with fever, cough, and muscle aches, and the clinician orders a test to determine whether the patient has influenza, RSV, or COVID-19. The lab analyst performs the 87637 procedure, and the results indicate the presence of SARS-CoV-2.
2. A patient with a known exposure to a confirmed COVID-19 case presents with mild symptoms. The clinician orders a test to determine whether the patient has COVID-19, influenza, or RSV. The lab analyst performs the 87637 procedure, and the results indicate the presence of influenza A.
3. A patient with a history of chronic obstructive pulmonary disease (COPD) presents with worsening respiratory symptoms. The clinician orders a test to determine whether the patient has influenza, RSV, or COVID-19. The lab analyst performs the 87637 procedure, and the results indicate the presence of RSV.
4. A patient presents with fever and cough, and the clinician orders a test to determine whether the patient has influenza, RSV, or COVID-19. The lab analyst performs the 87637 procedure, and the results indicate the presence of influenza B.
5. A patient with a known exposure to a confirmed RSV case presents with respiratory symptoms. The clinician orders a test to determine whether the patient has RSV, influenza, or COVID-19. The lab analyst performs the 87637 procedure, and the results indicate the presence of RSV.
6. A patient with a history of asthma presents with worsening respiratory symptoms. The clinician orders a test to determine whether the patient has influenza, RSV, or COVID-19. The lab analyst performs the 87637 procedure, and the results indicate the presence of influenza A.
7. A patient presents with fever, cough, and muscle aches, and the clinician orders a test to determine whether the patient has influenza, RSV, or COVID-19. The lab analyst performs the 87637 procedure, and the results indicate the absence of all four viral targets.
8. A patient with a known exposure to a confirmed influenza A case presents with respiratory symptoms. The clinician orders a test to determine whether the patient has influenza, RSV, or COVID-19. The lab analyst performs the 87637 procedure, and the results indicate the presence of influenza A.
9. A patient with a history of heart disease presents with fever and cough. The clinician orders a test to determine whether the patient has influenza, RSV, or COVID-19. The lab analyst performs the 87637 procedure, and the results indicate the presence of SARS-CoV-2.
10. A patient presents with fever, cough, and muscle aches, and the clinician orders a test to determine whether the patient has influenza, RSV, or COVID-19. The lab analyst performs the 87637 procedure, and the results indicate the presence of both influenza B and RSV.