How To Use CPT Code 87880

CPT 87880 is a diagnostic test code for detecting Streptococcus, group A, antigens using 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 87880.

1. What is CPT 87880?

CPT 87880 is a diagnostic test code used by medical professionals to identify the presence of Streptococcus, group A, antigens in a patient’s sample. This test is typically performed using an immunoassay method with direct optical observation, which allows for the rapid detection of the antigens. The results of this test can help clinicians diagnose and treat infections caused by Streptococcus, group A, such as pharyngitis (sore throat) and prevent complications like rheumatic fever and kidney failure.

2. 87880 CPT code description

The official description of CPT code 87880 is: “Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; Streptococcus, group A.”

3. Procedure

The 87880 procedure involves the following steps:

1. Collection of a patient’s sample, typically a throat swab.
2. Extraction of viral particles from the swab or washings.
3. Incubation of the extraction phase.
4. Adding the extracted liquid to a test device containing antibodies to Streptococcus, group A.
5. Observation of a color change, such as a colored line, indicating the presence of Strep A antigens.
6. Direct visual observation of the reaction by the analyst.

4. Qualifying circumstances

Patients who are eligible to receive CPT code 87880 services are those presenting with symptoms suggestive of a Streptococcus, group A, infection, such as pharyngitis or sore throat. The test may also be ordered for patients with a history of rheumatic fever or kidney disease, as early detection and treatment of Streptococcus, group A, infections can help prevent these complications.

5. When to use CPT code 87880

It is appropriate to bill the 87880 CPT code when a healthcare provider orders the test to diagnose a suspected Streptococcus, group A, infection in a patient presenting with relevant symptoms or risk factors. The test results can help guide the clinician’s decision on the appropriate treatment plan for the patient, such as prescribing antibiotics if the infection is confirmed.

6. Documentation requirements

To support a claim for CPT 87880, the following information needs to be documented:

• Patient’s demographic information, including name, date of birth, and insurance details.
• Relevant medical history, including any previous diagnoses or treatments related to Streptococcus, group A, infections.
• Presenting symptoms and their duration.
• Physical examination findings, particularly those related to the throat and tonsils.
• Order for the CPT 87880 test, including the clinical indication for the test.
• Results of the test, including the analyst’s direct visual observation of the reaction.
• Treatment plan based on the test results, such as the prescription of antibiotics or further diagnostic tests.

7. Billing guidelines

When billing for CPT code 87880, it is essential to follow the specific guidelines and rules set by the payer, such as Medicare or private insurance companies. Some tips for billing CPT 87880 include:

• Ensure that the documentation supports the medical necessity of the test, including the patient’s symptoms, risk factors, and treatment plan.
• Verify the payer’s requirements for prior authorization or referrals, if applicable.
• Use the appropriate modifiers, if necessary, to indicate any special circumstances related to the test, such as repeat testing or multiple tests performed on the same day.
• Submit the claim with the correct diagnosis codes (ICD-10) that correspond to the patient’s symptoms and the reason for the test.

8. Historical information

CPT 87880 was added to the Current Procedural Terminology system on January 1, 1998. There have been two updates to the code since its addition:

• Code Changed on 01-01-2009: “Infectious agent detection by immunoassay with direct optical observation; Streptococcus, group A.”
• Code Changed on 10-06-2020: “Infectious agent antigen detection by immunoassay with direct optical observation; Streptococcus, group A.”

9. Similar codes to CPT 87880

Five similar codes to CPT 87880 and how they differentiate are:

• CPT 87804: This code is for the detection of influenza virus antigens using immunoassay with direct optical observation.
• CPT 87430: This code is for the detection of adenovirus antigens using immunoassay with direct optical observation.
• CPT 87389: This code is for the detection of human immunodeficiency virus (HIV) antigens using immunoassay.
• CPT 87338: This code is for the detection of Haemophilus influenzae type B antigens using immunoassay.
• CPT 87449: This code is for the detection of respiratory syncytial virus antigens using immunoassay with direct optical observation.

10. Examples

Here are 10 detailed examples of CPT code 87880 procedures:

1. A 5-year-old child presenting with a sore throat, fever, and difficulty swallowing, with a history of rheumatic fever.
2. A 25-year-old adult with a sudden onset of severe sore throat, fever, and swollen lymph nodes in the neck.
3. A 40-year-old patient with a sore throat, headache, and rash, who has a family member recently diagnosed with a Streptococcus, group A, infection.
4. A 60-year-old patient with a history of kidney disease presenting with a sore throat and fever.
5. A 30-year-old patient with a sore throat, fever, and joint pain, who has a history of recurrent Streptococcus, group A, infections.
6. A 10-year-old child with a sore throat, fever, and abdominal pain, who has a sibling diagnosed with a Streptococcus, group A, infection.
7. A 50-year-old patient with a sore throat, fever, and difficulty swallowing, who has a history of tonsillitis.
8. A 20-year-old college student with a sore throat, fever, and swollen lymph nodes, who lives in a dormitory with a recent outbreak of Streptococcus, group A, infections.
9. A 35-year-old patient with a sore throat, fever, and rash, who works in a daycare center with a recent outbreak of Streptococcus, group A, infections.
10. A 45-year-old patient with a sore throat, fever, and difficulty swallowing, who has a history of rheumatic fever and is currently taking immunosuppressive medications.