How To Use CPT Code 87801

CPT 87801 is a code used for the detection of multiple infectious agents by nucleic acid (DNA or RNA) using amplified probe techniques. This article will cover the description, procedure, qualifying circumstances, when to use the code, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 87801 procedures.

1. What is CPT 87801?

CPT 87801 is a code used to represent the detection of multiple infectious agents by nucleic acid (DNA or RNA) using amplified probe techniques. This code is utilized when a lab analyst performs a test for multiple infectious agents using amplified nucleic acid probe techniques on a specimen from a direct source, such as sputum, pleural fluid from the chest, throat swab, or nasopharyngeal washings.

2. 87801 CPT code description

The official description of CPT code 87801 is: “Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; amplified probe(s) technique.”

3. Procedure

The procedure for CPT 87801 involves the following steps:

1. Collection of the specimen from a direct source, such as sputum, pleural fluid from the chest, throat swab, or nasopharyngeal washings.
2. Processing of the specimen by the lab analyst.
3. Amplification of specific target nucleic acid sequences using techniques such as polymerase chain reaction (PCR), resulting in a millionfold increase in the number of copies of the target sequences.
4. Assessment of the presence of the amplified nucleic acid sequences using a nucleic acid probe, which is a fabricated single strand sequence of DNA or RNA that joins with the complementary sequence in the specimen through a process called hybridization.
5. Visualization of the hybridization products using a label, such as a radioactive or chemical tag, on the nucleic acid probes.

4. Qualifying circumstances

Individuals eligible to receive CPT code 87801 services are those who require testing for multiple infectious agents using amplified nucleic acid probe techniques. This may include patients with suspected infections, those who have been exposed to infectious agents, or individuals undergoing routine screening for specific infectious diseases.

5. When to use CPT code 87801

It is appropriate to bill the 87801 CPT code when a lab analyst performs a single test that involves amplifying multiple DNA target sequences using techniques such as polymerase chain reaction, ligase chain reaction, or signal detection. This code should be used for a single test that involves multiple probes for multiple organisms.

6. Documentation requirements

To support a claim for CPT 87801, the following information needs to be documented:

• Patient’s demographic information, including name, date of birth, and medical record number.
• Relevant clinical history and physical examination findings.
• Indication for the test, such as suspected infection, exposure to infectious agents, or routine screening.
• Specimen type and collection method.
• Details of the amplification technique used, such as PCR or ligase chain reaction.
• Results of the nucleic acid probe hybridization, including the presence or absence of specific infectious agents.
• Interpretation of the test results by a qualified healthcare professional.

7. Billing guidelines

When billing for CPT code 87801, it is essential to follow the appropriate billing guidelines and rules. These may include:

• Ensuring that the test is medically necessary and supported by the patient’s clinical history and physical examination findings.
• Documenting the specific infectious agents tested for and the results of the nucleic acid probe hybridization.
• Using the appropriate modifiers, if necessary, to indicate any special circumstances related to the test.
• Submitting the claim with the correct diagnosis codes that support the medical necessity of the test.

8. Historical information

CPT 87801 was added to the Current Procedural Terminology system on January 1, 2001. There have been no updates to the code since its addition.

9. Similar codes to CPT 87801

Five similar codes to CPT 87801 and how they differentiate from CPT 87801 are:

1. CPT 87471 – This code is used for the detection of a single specific organism by nucleic acid (DNA or RNA) using amplified probe techniques.
2. CPT 87631 – This code is used for the detection of multiple respiratory viruses in a multiplex reaction (single procedure with multiple results) using nucleic acid (DNA or RNA) techniques.
3. CPT 87797 – This code is used for the detection of a single specific infectious agent not otherwise specified by nucleic acid (DNA or RNA) using amplified probe techniques.
4. CPT 87798 – This code is used for the detection of two specific infectious agents not otherwise specified by nucleic acid (DNA or RNA) using amplified probe techniques.
5. CPT 87799 – This code is used for the detection of three or more specific infectious agents not otherwise specified by nucleic acid (DNA or RNA) using amplified probe techniques.

10. Examples

Here are 10 detailed examples of CPT code 87801 procedures:

1. A patient with suspected pneumonia undergoes testing for multiple bacterial pathogens using sputum samples and amplified nucleic acid probe techniques.
2. A patient with a history of exposure to a healthcare-associated infection undergoes testing for multiple antibiotic-resistant bacteria using a throat swab and amplified nucleic acid probe techniques.
3. A patient with suspected meningitis undergoes testing for multiple bacterial and viral pathogens using cerebrospinal fluid samples and amplified nucleic acid probe techniques.
4. A patient with a fever of unknown origin undergoes testing for multiple infectious agents using blood samples and amplified nucleic acid probe techniques.
5. A patient with suspected sepsis undergoes testing for multiple bacterial pathogens using blood samples and amplified nucleic acid probe techniques.
6. A patient with a suspected sexually transmitted infection undergoes testing for multiple bacterial and viral pathogens using a genital swab and amplified nucleic acid probe techniques.
7. A patient with a history of travel to a region with endemic infectious diseases undergoes testing for multiple pathogens using blood samples and amplified nucleic acid probe techniques.
8. A patient with suspected viral gastroenteritis undergoes testing for multiple viral pathogens using stool samples and amplified nucleic acid probe techniques.
9. A patient with a suspected tick-borne illness undergoes testing for multiple bacterial and viral pathogens using blood samples and amplified nucleic acid probe techniques.
10. A patient undergoing routine screening for healthcare-associated infections undergoes testing for multiple bacterial pathogens using a nasal swab and amplified nucleic acid probe techniques.