CPT 87389 is a code used for HIV-1 antigen detection with HIV-1 and HIV-2 antibodies through immunoassay techniques, providing a single result. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 87389 procedures.
1. What is CPT 87389?
CPT 87389 is a code used in the medical billing and coding field to represent a specific laboratory test that screens for human immunodeficiency virus (HIV) antigens and antibodies. This test is performed using immunoassay techniques and provides a single result that does not distinguish between the antigens and antibodies.
2. 87389 CPT code description
The official description of CPT code 87389 is: “Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]), qualitative or semiquantitative; HIV-1 antigen(s), with HIV-1 and HIV-2 antibodies, single result.”
The procedure for CPT 87389 involves the following steps:
- Collection of a primary source specimen from the patient, such as serum.
- Preparation of the specimen for testing using immunoassay techniques, such as EIA, ELISA, FIA, or IMCA.
- Assessment of the presence of HIV-1 antigens (e.g., HIV p24) and HIV-1 and HIV-2 antibodies in the specimen.
- Analysis and interpretation of the test results, providing a single result that does not distinguish between the antigens and antibodies.
- Reporting of the test results to the ordering clinician for further evaluation and potential confirmatory testing.
4. Qualifying circumstances
Patients who are eligible to receive CPT 87389 services include those who:
- Are suspected of having an HIV infection based on clinical symptoms, risk factors, or exposure history.
- Require routine HIV screening as part of a comprehensive preventive care plan or due to specific guidelines for certain populations (e.g., pregnant women).
- Have had a previous indeterminate or inconclusive HIV test result and require further testing.
- Are undergoing monitoring for HIV infection as part of their ongoing medical care.
5. When to use CPT code 87389
It is appropriate to bill the 87389 CPT code when a clinician orders an HIV screening test using immunoassay techniques for the detection of HIV-1 antigens and HIV-1 and HIV-2 antibodies, and the test provides a single result. This code should be used for primary source specimens and not for testing culture isolates.
6. Documentation requirements
To support a claim for CPT 87389, the following information should be documented:
- The patient’s clinical history, symptoms, risk factors, or exposure history that justify the need for HIV testing.
- The specific immunoassay technique used for the test (e.g., EIA, ELISA, FIA, or IMCA).
- A detailed description of the test procedure, including specimen collection, preparation, and analysis.
- The test results, including the single result that does not distinguish between the antigens and antibodies.
- Any additional testing or follow-up care recommended based on the test results.
7. Billing guidelines
When billing for CPT code 87389, keep in mind the following guidelines and tips:
- Some payers may pay separately for collecting the specimen using a code such as 36415 for venipuncture.
- Distinguish 87389 for HIV-1 and HIV-2 immunoassay testing from 87390 for HIV-1 immunoassay testing, and 87391 for HIV-2 immunoassay testing.
- Use this code only for immunoassay tests that yield a single result for HIV-1 antigens and HIV-1 and HIV-2 antibodies.
- Reserve this code for primary source specimens; don’t use this code for testing culture isolates, but turn to other codes such as 87140 to 87158 instead.
- If the lab analyst performs this test for different species or strains of the organism, or different organisms, separately report each test with modifier 59.
8. Historical information
CPT 87389 was added to the Current Procedural Terminology system on January 1, 2012. Since then, there have been several updates to the code description, with the most recent change occurring on January 1, 2022.
9. Similar codes to CPT 87389
Five similar codes to CPT 87389 and how they differentiate are:
- CPT 87390: This code is used for HIV-1 immunoassay testing only, without the inclusion of HIV-2 antibodies.
- CPT 87391: This code is used for HIV-2 immunoassay testing only, without the inclusion of HIV-1 antigens.
- CPT 86701 to 86703: These codes are used for HIV antibody tests only, without the inclusion of HIV-1 antigens.
- CPT 87534 to 87539: These codes are used for HIV antigen tests by different methods, not immunoassay techniques.
- CPT 87901 to 87906: These codes are used for HIV genotype analysis, which is a different type of testing than immunoassay.
Here are 10 detailed examples of CPT code 87389 procedures:
- A patient with a history of intravenous drug use presents with flu-like symptoms and is tested for HIV using CPT 87389.
- A pregnant woman undergoes routine HIV screening as part of her prenatal care using CPT 87389.
- A patient who had a recent sexual encounter with an HIV-positive partner is tested for HIV using CPT 87389.
- A healthcare worker who experienced a needlestick injury is tested for HIV using CPT 87389 as part of post-exposure prophylaxis.
- A patient with a previous indeterminate HIV test result undergoes further testing using CPT 87389.
- A patient undergoing treatment for a sexually transmitted infection is tested for HIV using CPT 87389 as part of a comprehensive evaluation.
- A patient with a history of multiple sexual partners and inconsistent condom use is tested for HIV using CPT 87389.
- A patient who received a blood transfusion before 1985 is tested for HIV using CPT 87389 due to the risk of transmission through blood products.
- A patient with a history of tuberculosis is tested for HIV using CPT 87389 due to the increased risk of HIV infection in individuals with tuberculosis.
- A patient undergoing preoperative evaluation for a kidney transplant is tested for HIV using CPT 87389 as part of the transplant eligibility assessment.