How To Use CPT Code 87651

CPT 87651 refers to the detection of Streptococcus, group A, by nucleic acid (DNA or RNA) using an amplified probe technique. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 87651.

1. What is CPT 87651?

CPT 87651 is a code used to describe the laboratory procedure for detecting the presence of Streptococcus, group A, in a patient’s specimen using an amplified nucleic acid probe technique. This test is commonly used to diagnose infections caused by Streptococcus, group A, such as acute pharyngitis or strep throat.

2. 87651 CPT code description

The official description of CPT code 87651 is: “Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group A, amplified probe technique.”

3. Procedure

  1. The lab analyst collects a specimen from the patient, typically a throat swab.
  2. The specimen is processed and prepared for analysis.
  3. Amplification techniques, such as polymerase chain reaction (PCR), are used to increase the number of copies of the target nucleic acid sequence.
  4. A nucleic acid probe, labeled with a radioactive or chemical tag, is used to detect the presence of the amplified nucleic acid sequences specific to Streptococcus, group A.
  5. The probe binds to the complementary sequence in the specimen through a process called hybridization.
  6. The lab analyst visualizes the hybridization product to determine the presence of Streptococcus, group A.

4. Qualifying circumstances

Patients who are eligible to receive CPT code 87651 services are those presenting with symptoms suggestive of an infection caused by Streptococcus, group A, such as a sore throat, fever, or swollen lymph nodes. Clinicians may order this test to confirm the diagnosis and guide appropriate treatment.

5. When to use CPT code 87651

It is appropriate to bill the 87651 CPT code when a laboratory performs the aforementioned procedure to detect the presence of Streptococcus, group A, in a patient’s specimen using an amplified nucleic acid probe technique. This code should be used when the clinician suspects an infection caused by Streptococcus, group A, and requires laboratory confirmation for diagnosis and treatment planning.

6. Documentation requirements

To support a claim for CPT 87651, the following information should be documented:

  • Patient’s demographic information, including name, date of birth, and insurance information.
  • Clinical history and presenting symptoms suggestive of a Streptococcus, group A, infection.
  • Date and time of specimen collection.
  • Type of specimen collected (e.g., throat swab).
  • Details of the laboratory procedure, including amplification technique and nucleic acid probe used.
  • Results of the test, including the presence or absence of Streptococcus, group A.
  • Interpretation of the results by a qualified professional.

7. Billing guidelines

When billing for CPT code 87651, it is essential to ensure that the documentation supports the medical necessity of the test. The claim should include the appropriate diagnosis code(s) that correspond to the patient’s symptoms and clinical presentation. Additionally, it is crucial to verify the payer’s specific requirements and guidelines for billing this code, as some payers may have unique rules or restrictions.

8. Historical information

CPT 87651 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 87651

Five similar codes to CPT 87651 and how they differ are:

  • CPT 87650: This code is used for the detection of Streptococcus, group A, using a direct nucleic acid probe technique, rather than an amplified probe technique.
  • CPT 87652: This code is used for the detection and quantification of Streptococcus, group A, using a nucleic acid probe technique.
  • CPT 87501: This code is used for the detection of infectious agents by nucleic acid (DNA or RNA) using an amplified probe technique, but it is specific to the identification of influenza virus.
  • CPT 87502: This code is used for the detection and quantification of infectious agents by nucleic acid (DNA or RNA) using a probe technique, specific to the identification of influenza virus.
  • CPT 87471: This code is used for the detection of infectious agents by nucleic acid (DNA or RNA) using a direct probe technique, specific to the identification of Bordetella pertussis.

10. Examples

  1. A 7-year-old child presents with a sore throat, fever, and swollen lymph nodes. The clinician suspects a Streptococcus, group A, infection and orders a test using CPT 87651.
  2. A 25-year-old adult presents with a severe sore throat and difficulty swallowing. The clinician orders a test using CPT 87651 to confirm the presence of Streptococcus, group A, infection.
  3. A 45-year-old patient with a history of recurrent strep throat presents with a sore throat and fever. The clinician orders a test using CPT 87651 to determine if the current symptoms are due to a Streptococcus, group A, infection.
  4. A 60-year-old patient with a compromised immune system presents with a sore throat and swollen lymph nodes. The clinician orders a test using CPT 87651 to confirm the presence of Streptococcus, group A, infection and guide appropriate treatment.
  5. A 15-year-old patient presents with a sore throat, fever, and a rash. The clinician suspects a Streptococcus, group A, infection and orders a test using CPT 87651.
  6. A 35-year-old patient presents with a sore throat and difficulty swallowing, accompanied by a high fever. The clinician orders a test using CPT 87651 to confirm the presence of Streptococcus, group A, infection.
  7. A 50-year-old patient with a history of rheumatic fever presents with a sore throat and fever. The clinician orders a test using CPT 87651 to determine if the current symptoms are due to a Streptococcus, group A, infection.
  8. A 20-year-old patient presents with a sore throat, fever, and headache. The clinician suspects a Streptococcus, group A, infection and orders a test using CPT 87651.
  9. A 30-year-old patient presents with a sore throat and swollen lymph nodes, accompanied by a high fever. The clinician orders a test using CPT 87651 to confirm the presence of Streptococcus, group A, infection.
  10. A 40-year-old patient with a history of recurrent tonsillitis presents with a sore throat and fever. The clinician orders a test using CPT 87651 to determine if the current symptoms are due to a Streptococcus, group A, infection.

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