How To Use CPT Code 87811

CPT 87811 is a code used for the detection of SARS-CoV-2 (COVID-19) through immunoassay with direct optical observation. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 87811.

1. What is CPT 87811?

CPT 87811 is a medical code used to describe the procedure of detecting the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease (COVID-19), in a patient’s specimen through immunoassay with direct optical observation. This test is typically performed in a laboratory or clinical setting and is essential for diagnosing and managing COVID-19 cases.

2. 87811 CPT code description

The official description of CPT code 87811 is: “Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19])”.

3. Procedure

The procedure for CPT 87811 involves the following steps:

1. Collection of a specimen from the patient, typically a nasopharyngeal swab.
2. Placing the swab in a reagent containing antibodies specific to SARS-CoV-2 antigens.
3. Adding the liquid mixture to a card or device designed for optical observation.
4. Observing the card or device for a color change, line, or other visual indicator of the presence of SARS-CoV-2.
5. Interpreting the results and reporting them to the ordering clinician.

4. Qualifying circumstances

Patients eligible to receive CPT code 87811 services are those who exhibit symptoms consistent with COVID-19, such as fever, cough, and muscle aches, or those who have been exposed to a confirmed COVID-19 case. Additionally, asymptomatic individuals may be tested if they are part of a high-risk group, such as healthcare workers, first responders, or residents of long-term care facilities.

5. When to use CPT code 87811

CPT code 87811 should be used when a clinician orders a test to detect the presence of SARS-CoV-2 in a patient’s specimen using immunoassay with direct optical observation. This test is appropriate for diagnosing COVID-19 and managing patient care, as well as for screening purposes in high-risk populations.

6. Documentation requirements

To support a claim for CPT 87811, the following information must be documented:

• Patient’s demographic information, including name, date of birth, and insurance information.
• Ordering clinician’s information, including name, contact details, and National Provider Identifier (NPI) number.
• Indication for the test, such as symptoms, exposure history, or high-risk status.
• Date and time of specimen collection.
• Details of the test performed, including the type of immunoassay and optical observation method used.
• Test results and interpretation.
• Any relevant clinical notes or observations.

7. Billing guidelines

When billing for CPT code 87811, it is essential to follow the appropriate guidelines and rules. Ensure that the documentation supports the medical necessity of the test and that all required information is included in the patient’s record. Additionally, be aware of any payer-specific requirements or policies related to COVID-19 testing and reimbursement.

8. Historical information

CPT 87811 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 87811

Five similar codes to CPT 87811 and how they differ are:

1. CPT 87426: This code is used for the detection of SARS-CoV-2 and SARS-CoV antigens through immunoassay without direct optical observation.
2. CPT 87635: This code is for the detection of SARS-CoV-2 through nucleic acid amplification techniques, such as PCR.
3. CPT 86769: This code is for the detection of SARS-CoV-2 antibodies in a patient’s serum or plasma.
4. CPT 86328: This code is for the detection of SARS-CoV-2 antibodies through immunoassay with direct optical observation.
5. CPT 87275: This code is for the detection of other respiratory viruses, such as influenza, through immunoassay with direct optical observation.

10. Examples

Here are ten detailed examples of CPT code 87811 procedures:

1. A patient presents with fever, cough, and shortness of breath. The clinician orders a COVID-19 test using CPT 87811.
2. A healthcare worker with no symptoms is tested for COVID-19 as part of routine screening using CPT 87811.
3. A patient who has been in close contact with a confirmed COVID-19 case is tested using CPT 87811.
4. A resident of a long-term care facility with a recent outbreak of COVID-19 is tested using CPT 87811.
5. A patient with a history of recent international travel and mild respiratory symptoms is tested for COVID-19 using CPT 87811.
6. A first responder with no symptoms is tested for COVID-19 as part of routine screening using CPT 87811.
7. A patient with a weakened immune system and respiratory symptoms is tested for COVID-19 using CPT 87811.
8. A patient who has recovered from COVID-19 is tested for the presence of the virus using CPT 87811 before returning to work.
9. A patient with a high fever and severe cough is tested for COVID-19 using CPT 87811 to rule out other respiratory infections.
10. A patient with a known exposure to COVID-19 and mild symptoms is tested using CPT 87811 to confirm the diagnosis and guide treatment.