How To Use CPT Code 81513

CPT 81513 describes the quantitative real-time amplification of RNA markers for Atopobium vaginae, Gardnerella vaginalis, and Lactobacillus species in vaginal-fluid specimens, utilizing a standardized algorithm to report a positive or negative result for bacterial vaginosis. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 81513?

CPT 81513 is used to describe a lab test that quantitatively amplifies RNA markers for three bacterial species in vaginal-fluid specimens. The test utilizes a standardized algorithm to determine and report whether the patient has bacterial vaginosis (BV) or not. BV is a common cause of abnormal vaginal discharge and is associated with reproductive problems, sexually transmitted infections, and pelvic inflammatory disease.

2. Official Description

The official description of CPT code 81513 is: ‘Infectious disease, bacterial vaginosis, quantitative real-time amplification of RNA markers for Atopobium vaginae, Gardnerella vaginalis, and Lactobacillus species, utilizing vaginal-fluid specimens, algorithm reported as a positive or negative result for bacterial vaginosis.’

3. Procedure

1. The lab analyst extracts nucleic acids from the vaginal-fluid specimen and amplifies the RNA markers for Atopobium vaginae, Gardnerella vaginalis, and Lactobacillus species.
2. The lab analyst uses reverse transcription PCR (RT-PCR) to create copy DNA (cDNA) for amplification and quantification using real-time PCR (qPCR).
3. The lab analyst carries out an algorithmic analysis using patient data and the lab test results to determine if the patient has bacterial vaginosis or not.
4. The lab reports the findings as a positive or negative result for bacterial vaginosis.

4. Qualifying circumstances

CPT 81513 is ordered for patients with symptoms of bacterial vaginosis, such as abnormal vaginal discharge. The test is performed on vaginal-fluid specimens and requires the presence of RNA markers for Atopobium vaginae, Gardnerella vaginalis, and Lactobacillus species. The algorithmic analysis is used to determine the presence or absence of bacterial vaginosis based on the lab test results and patient data.

5. When to use CPT code 81513

CPT code 81513 should be used when a lab test is performed to quantitatively amplify RNA markers for Atopobium vaginae, Gardnerella vaginalis, and Lactobacillus species in vaginal-fluid specimens. The test utilizes a standardized algorithm to report a positive or negative result for bacterial vaginosis. It is appropriate to use this code when the lab test is performed for diagnostic purposes or to monitor the effectiveness of treatment for bacterial vaginosis.

6. Documentation requirements

To support a claim for CPT 81513, the documentation should include:

• Indication for the test, such as symptoms of bacterial vaginosis
• Details of the lab test performed, including the extraction and amplification of RNA markers
• Results of the algorithmic analysis, reported as a positive or negative result for bacterial vaginosis
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT 81513, ensure that the lab test includes the quantitative amplification of RNA markers for Atopobium vaginae, Gardnerella vaginalis, and Lactobacillus species in vaginal-fluid specimens. The test should utilize a standardized algorithm to report a positive or negative result for bacterial vaginosis. It is important to note that separate reporting of the underlying lab tests is not necessary, as CPT 81513 includes all technical lab tests and algorithmic analysis for bacterial vaginosis.

8. Historical information

CPT 81513 was added to the Current Procedural Terminology system on January 1, 2021. There have been no updates to the code since its addition.

9. Examples

1. A patient presents with symptoms of bacterial vaginosis, including abnormal vaginal discharge. The lab performs CPT 81513 to quantitatively amplify RNA markers for Atopobium vaginae, Gardnerella vaginalis, and Lactobacillus species in the vaginal-fluid specimen. The algorithmic analysis determines that the patient has bacterial vaginosis, and the lab reports a positive result.
2. A healthcare provider orders CPT 81513 to monitor the effectiveness of treatment for a patient with recurrent bacterial vaginosis. The lab performs the test on a vaginal-fluid specimen and reports a negative result, indicating that the treatment has been successful in resolving the bacterial vaginosis.
3. A pregnant patient with a history of preterm birth undergoes CPT 81513 to screen for bacterial vaginosis. The lab performs the test on a vaginal-fluid specimen and reports a positive result, indicating the presence of bacterial vaginosis. The healthcare provider can then initiate appropriate interventions to reduce the risk of preterm birth.
4. A patient with recurrent urinary tract infections undergoes CPT 81513 to investigate the underlying cause. The lab performs the test on a vaginal-fluid specimen and reports a negative result for bacterial vaginosis, suggesting that the urinary tract infections may be unrelated to this condition.
5. A healthcare provider orders CPT 81513 for a patient with persistent symptoms of bacterial vaginosis despite previous treatment. The lab performs the test on a vaginal-fluid specimen and reports a positive result, indicating that the bacterial vaginosis has not been effectively treated and further interventions are necessary.