How To Use CPT Code 87172

CPT 87172 describes the pinworm exam, which is used to diagnose pinworm infection. 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 87172?

CPT 87172 is used to describe the pinworm exam, a diagnostic test used to detect pinworm infection. This test involves examining a specimen collected using a pinworm paddle or transparent adhesive tape to look for pinworm eggs or adults. The lab analyst observes the specimen with the naked eye and under a microscope to identify the presence of pinworms or their eggs.

2. Official Description

The official description of CPT code 87172 is: ‘Pinworm exam (eg, cellophane tape prep)’. This code is used to report the examination of a specimen collected using a pinworm paddle or transparent adhesive tape to detect pinworm eggs or adults.

3. Procedure

1. The pinworm exam begins with the collection of a specimen using a pinworm paddle or transparent adhesive tape.
2. The specimen is then examined by a lab analyst.
3. The analyst observes the specimen with the naked eye to look for adult pinworms.
4. The specimen is also observed under a microscope to try to find pinworm eggs, which are transparent and very small.
5. If pinworms or their eggs are found, the test is considered positive for pinworm infection.

4. Qualifying circumstances

The pinworm exam, represented by CPT 87172, is typically ordered by clinicians to aid in the diagnosis of pinworm infection. Pinworms are parasites that live in the rectum of humans and exit the intestine through the anus while the patient is sleeping, depositing eggs on the skin around the anus. The eggs can be transmitted to another host on clothing, bedding, or other objects. The pinworm exam is not limited to a specific condition and can be used for any patient suspected of having a pinworm infection.

5. When to use CPT code 87172

CPT code 87172 should be used when a pinworm exam is performed to detect pinworm infection. This code is appropriate when a specimen collected using a pinworm paddle or transparent adhesive tape is examined to identify the presence of pinworms or their eggs. It is important to note that this code should not be used for other types of examinations or tests.

6. Documentation requirements

To support a claim for CPT 87172, the documentation should include:

• Reason for ordering the pinworm exam
• Details of the specimen collection method used (pinworm paddle or transparent adhesive tape)
• Observations made during the examination, including the presence of pinworms or their eggs
• Results of the exam, indicating whether the test was positive or negative for pinworm infection
• Signature of the lab analyst who performed the examination

7. Billing guidelines

When billing for CPT 87172, ensure that the pinworm exam was performed using a pinworm paddle or transparent adhesive tape. This code should not be reported with other codes unless there are additional services provided that are separately identifiable. It is important to follow the specific guidelines provided by the payer to ensure accurate and appropriate billing.

8. Historical information

CPT 87172 was added to the Current Procedural Terminology system on January 1, 2001. There have been no updates or changes to the code since its addition.

9. Examples

1. A clinician orders a pinworm exam for a child who presents with symptoms of itching around the anus. The pinworm paddle is used to collect a specimen, which is then examined by a lab analyst. The exam reveals the presence of pinworm eggs, confirming the diagnosis of pinworm infection.
2. A school nurse suspects a pinworm infection in a student who complains of anal itching. The nurse collects a specimen using transparent adhesive tape and sends it to the lab for examination. The pinworm exam confirms the presence of pinworms, and appropriate treatment is initiated.
3. A parent brings their child to the pediatrician with complaints of restless sleep and anal itching. The pediatrician orders a pinworm exam, and a specimen is collected using a pinworm paddle. The exam reveals the presence of pinworms, confirming the diagnosis of pinworm infection.
4. A primary care physician suspects a pinworm infection in an adult patient who complains of anal itching. The physician collects a specimen using transparent adhesive tape and sends it to the lab for examination. The pinworm exam comes back negative, ruling out pinworm infection as the cause of the patient’s symptoms.
5. A gastroenterologist orders a pinworm exam for a patient with unexplained abdominal pain. The lab analyst examines a specimen collected using a pinworm paddle and finds no evidence of pinworms or their eggs, indicating that pinworm infection is not the cause of the patient’s symptoms.