How To Use CPT Code 87426

CPT 87426 is a code used for detecting severe acute respiratory syndrome coronavirus antigens through immunoassay techniques. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 87426.

1. What is CPT 87426?

CPT 87426 is a medical billing code used to report the detection of infectious agent antigens, specifically severe acute respiratory syndrome coronavirus (SARS-CoV, SARS-CoV-2 [COVID-19]), through immunoassay techniques. This code is used when a lab analyst performs a qualitative or semiquantitative evaluation of a patient’s blood specimen for antigens related to the coronavirus.

2. 87426 CPT code description

The official description of CPT code 87426 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; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19])”.

3. Procedure

The procedure for CPT 87426 involves the following steps:

  1. The lab analyst collects a patient’s blood specimen, typically whole blood or serum.
  2. The analyst performs an immunoassay using techniques such as enzyme immunoassay (EIA), enzyme-linked immunosorbent assay (ELISA), fluorescence immunoassay (FIA), or immunochemiluminometric assay (IMCA) to detect the presence of severe acute respiratory syndrome coronavirus antigens.
  3. For example, the test may include swirling a sample swab in a reagent tube to release the antigen, and then transferring a portion to a test cassette sample well.
  4. The lab analyst places the sample cassette and quality control cassettes in an analyzer to obtain the result.

4. Qualifying circumstances

Patients eligible to receive CPT code 87426 services are those who are suspected of having a severe acute respiratory syndrome coronavirus infection, such as SARS-CoV-2, which causes COVID-19. Clinicians may order this test to determine if the patient has a viral infection and to support a diagnosis of COVID-19.

5. When to use CPT code 87426

It is appropriate to bill the 87426 CPT code when a lab analyst performs an immunoassay to detect the presence of severe acute respiratory syndrome coronavirus antigens in a patient’s blood specimen. This code is typically used when a clinician suspects a patient has a SARS-CoV-2 viral infection and requires confirmation for a diagnosis of COVID-19.

6. Documentation requirements

To support a claim for CPT 87426, the following information should be documented:

  • Patient’s demographic information, including name, date of birth, and insurance information.
  • Medical history and clinical presentation of the patient, including symptoms and any known exposure to SARS-CoV-2.
  • Ordering clinician’s information, including name, contact details, and National Provider Identifier (NPI) number.
  • Details of the immunoassay technique used, such as EIA, ELISA, FIA, or IMCA.
  • Results of the antigen detection test, including whether the test was positive or negative for SARS-CoV-2 antigens.
  • Any additional relevant clinical information or test results that support the use of CPT 87426.

7. Billing guidelines

When billing for CPT code 87426, it is essential to follow the specific guidelines and rules set by the payer. Some payers may pay separately for collecting the specimen using a code such as 36415. Additionally, it is crucial to ensure that the documentation requirements mentioned above are met to support the claim for CPT 87426.

8. Historical information

CPT 87426 was added to the Current Procedural Terminology system on June 25, 2020. There have been two changes to the code since its addition:

  • Code Changed on October 6, 2020: The previous descriptor was “Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19])”.
  • Code Changed on January 1, 2022: The descriptor was updated to its current form.

9. Similar codes to CPT 87426

Five similar codes to CPT 87426 and how they differentiate are:

  1. CPT 87301: This code is used for infectious agent antigen detection by immunoassay technique, but it is not specific to SARS-CoV-2.
  2. CPT 87635: This code is used for SARS-CoV-2 DNA or RNA nucleic acid detection by amplified probe technique, which is different from the immunoassay technique used in CPT 87426.
  3. CPT 86328: This code is for a single-step immunoassay using a reagent strip, such as might be used for point-of-care testing for SARS-CoV-2 antibodies, rather than antigen detection.
  4. CPT 86769: This code is for a multiple-step immunoassay using a reagent strip, such as might be used for point-of-care testing for SARS-CoV-2 antibodies, rather than antigen detection.
  5. HCPCS Level II codes U0001 and U0002: These codes are used for laboratory testing for the SARS-CoV-2 virus, with U0001 specifically for the CDC-developed kit and U0002 for tests developed by other labs.

10. Examples

Here are 10 detailed examples of CPT code 87426 procedures:

  1. A patient presents with fever, cough, and shortness of breath, and has a known exposure to a COVID-19 positive individual. The clinician orders an immunoassay test to detect SARS-CoV-2 antigens, and the lab analyst performs the test using an ELISA technique.
  2. A patient with a recent travel history to a COVID-19 hotspot develops symptoms consistent with the infection. The clinician orders a SARS-CoV-2 antigen test, and the lab analyst performs the test using an EIA technique.
  3. A patient with a weakened immune system presents with symptoms suggestive of COVID-19. The clinician orders a SARS-CoV-2 antigen test, and the lab analyst performs the test using an FIA technique.
  4. A patient who works in a high-risk environment, such as a healthcare facility, develops symptoms consistent with COVID-19. The clinician orders a SARS-CoV-2 antigen test, and the lab analyst performs the test using an IMCA technique.
  5. A patient with a history of close contact with a COVID-19 positive individual develops symptoms consistent with the infection. The clinician orders a SARS-CoV-2 antigen test, and the lab analyst performs the test using an ELISA technique.
  6. A patient with underlying health conditions presents with symptoms suggestive of COVID-19. The clinician orders a SARS-CoV-2 antigen test, and the lab analyst performs the test using an EIA technique.
  7. A patient who attended a large gathering where COVID-19 cases were reported develops symptoms consistent with the infection. The clinician orders a SARS-CoV-2 antigen test, and the lab analyst performs the test using an FIA technique.
  8. A patient with a history of respiratory illnesses presents with symptoms suggestive of COVID-19. The clinician orders a SARS-CoV-2 antigen test, and the lab analyst performs the test using an IMCA technique.
  9. A patient who lives in a long-term care facility develops symptoms consistent with COVID-19. The clinician orders a SARS-CoV-2 antigen test, and the lab analyst performs the test using an ELISA technique.
  10. A patient with a family member who tested positive for COVID-19 develops symptoms consistent with the infection. The clinician orders a SARS-CoV-2 antigen test, and the lab analyst performs the test using an EIA technique.

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