How To Use CPT Code 87420

CPT 87420 describes the detection of respiratory syncytial virus (RSV) antigens using an immunoassay technique. 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 87420?

CPT 87420 can be used to detect respiratory syncytial virus (RSV) antigens using an immunoassay technique. This code is used when a lab analyst performs a test on a primary source specimen, such as a suction or washing specimen from the nasal and throat region, to assess the presence of RSV antigens. The immunoassay technique may include methods like enzyme immunoassay (EIA), enzyme-linked immunosorbent assay (ELISA), fluorescence immunoassay (FIA), or immunochemiluminometric assay (IMCA).

2. Official Description

The official description of CPT code 87420 is: ‘Infectious agent antigen detection by immunoassay technique (eg, EIA, ELISA, FIA, IMCA), qualitative or semiquantitative; respiratory syncytial virus.’

3. Procedure

1. The lab analyst performs an immunoassay technique on a primary source specimen from the patient, such as a suction or washing specimen from the nasal and throat region.
2. The lab analyst assesses the presence of respiratory syncytial virus antigens, which are specific protein particles on the virus, using methods like EIA, ELISA, FIA, or IMCA.

4. Qualifying circumstances

CPT 87420 is used when clinicians suspect or want to rule out a respiratory syncytial virus infection in a patient. This test can be ordered for patients of any age group. It is important to note that this code is specifically for the detection of RSV antigens and should not be used for testing culture isolates or for detecting antibodies to RSV.

5. When to use CPT code 87420

CPT code 87420 should be used when a lab analyst performs an immunoassay technique on a primary source specimen to detect respiratory syncytial virus antigens. It is appropriate to use this code when there is a clinical suspicion of RSV infection and the test is performed using an immunoassay technique.

6. Documentation requirements

To support a claim for CPT 87420, the documentation should include:

• Indication for the test, such as clinical suspicion of RSV infection
• Type of immunoassay technique used, such as EIA, ELISA, FIA, or IMCA
• Date and time of the test
• Results of the test, indicating the presence or absence of RSV antigens
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT 87420, ensure that the test is performed using an immunoassay technique and that the documentation supports the medical necessity of the test. This code should not be reported for testing culture isolates or for detecting antibodies to RSV. If the lab analyst performs this test for different species or strains of the virus, or different organisms, each test should be reported separately with modifier 59 to indicate distinct procedural service.

8. Historical information

CPT 87420 was added to the Current Procedural Terminology system on January 1, 1998. There have been several updates to the code since its addition, including changes in the code description and methodology.

9. Examples

1. A lab analyst performs an immunoassay technique on a primary source specimen from a pediatric patient to detect respiratory syncytial virus antigens.
2. A lab analyst uses an enzyme immunoassay (EIA) to assess the presence of respiratory syncytial virus antigens in a nasal and throat washing specimen from an elderly patient.
3. A lab analyst performs a fluorescence immunoassay (FIA) on a suction specimen from an infant to detect respiratory syncytial virus antigens.
4. A lab analyst utilizes an immunochemiluminometric assay (IMCA) to assess the presence of respiratory syncytial virus antigens in a nasal swab specimen from a young child.
5. A lab analyst performs an enzyme-linked immunosorbent assay (ELISA) on a throat washing specimen from an adult patient to detect respiratory syncytial virus antigens.