How To Use CPT Code 87425

CPT 87425 describes the detection of rotavirus 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 87425?

CPT 87425 can be used to detect the presence of rotavirus antigens in a patient’s specimen using an immunoassay technique. This code is specifically used for qualitative or semiquantitative assessments of rotavirus antigens, which are specific protein particles found on the virus.

2. Official Description

The official description of CPT code 87425 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; rotavirus.’

3. Procedure

1. The lab analyst performs an immunoassay technique on a primary source specimen, such as stool, to detect the presence of rotavirus antigens.
2. The immunoassay technique may involve methods such as enzyme immunoassay (EIA), enzyme-linked immunosorbent assay (ELISA), fluorescence immunoassay (FIA), or immunochemiluminometric assay (IMCA).
3. The lab analyst performs all technical steps to assess the presence of rotavirus antigens in the specimen.
4. The test is performed to diagnose or rule out possible infection with rotavirus, which is a virus that commonly causes inflammation of the digestive tract, especially in young children or patients with compromised immune systems.
5. Common symptoms of rotavirus infection include vomiting, diarrhea, and possible dehydration.

4. Qualifying circumstances

CPT 87425 is used when there is a need to detect rotavirus antigens in a patient’s specimen. This test is typically ordered by clinicians to diagnose or rule out possible rotavirus infection. It is important to note that this code should only be used for primary source specimens, such as stool, and not for testing culture isolates. If the lab analyst performs this test for different species or strains of the rotavirus, or different organisms, each test should be separately reported with modifier 59 to indicate distinct procedural service.

5. When to use CPT code 87425

CPT code 87425 should be used when there is a need to detect rotavirus antigens in a patient’s specimen using an immunoassay technique. This code is appropriate for qualitative or semiquantitative assessments of rotavirus antigens. It should not be used for testing antibodies to rotavirus, as there are separate codes available for that purpose.

6. Documentation requirements

To support a claim for CPT code 87425, the documentation should include:

• Indication of the need for rotavirus antigen detection
• Details of the immunoassay technique used, such as EIA, ELISA, FIA, or IMCA
• Date of the test and the specimen source
• Results of the test, indicating the presence or absence of rotavirus antigens
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT code 87425, ensure that the test is performed using an immunoassay technique to detect rotavirus antigens. This code should not be reported for testing culture isolates. If the lab analyst performs this test for different species or strains of the rotavirus, or different organisms, each test should be separately reported with modifier 59. It is important to note that if the test is for detecting antibodies to rotavirus, a different code should be used. Review the specific guidelines and tips provided by the payer to ensure accurate billing.

8. Historical information

CPT code 87425 was added to the Current Procedural Terminology system on January 1, 1998. Since then, there have been several updates to the code, including changes in the description and methodology. The most recent update was on January 1, 2022, which revised the description of the code.

9. Examples

1. A lab analyst performs an immunoassay technique on a stool specimen to detect rotavirus antigens.
2. A clinician orders CPT code 87425 to diagnose a possible rotavirus infection in a young child with symptoms of vomiting and diarrhea.
3. The lab analyst uses an enzyme immunoassay (EIA) method to assess the presence of rotavirus antigens in a patient’s stool specimen.
4. CPT code 87425 is reported when a patient with a compromised immune system presents with symptoms of inflammation of the digestive tract, and the clinician suspects rotavirus infection.
5. A lab analyst performs a fluorescence immunoassay (FIA) to detect rotavirus antigens in a stool specimen from a patient with suspected rotavirus infection.
6. CPT code 87425 is used to assess the presence of rotavirus antigens in a primary source specimen, such as stool, to confirm a diagnosis of rotavirus infection.
7. A clinician orders CPT code 87425 to rule out rotavirus infection in a patient with symptoms of vomiting and diarrhea.
8. The lab analyst performs an immunochemiluminometric assay (IMCA) to detect rotavirus antigens in a patient’s stool specimen.
9. CPT code 87425 is reported when a clinician suspects rotavirus infection in a young child with symptoms of dehydration and diarrhea.
10. A lab analyst uses an enzyme-linked immunosorbent assay (ELISA) to assess the presence of rotavirus antigens in a stool specimen from a patient with suspected rotavirus infection.