How To Use CPT Code 87427

CPT 87427 describes the detection of shiga-like toxins 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 87427?

CPT 87427 can be used to detect shiga-like toxins using an immunoassay technique. This code is used when a lab analyst performs a test on a primary source specimen, such as stool, to assess the presence of shiga-like toxins produced by organisms like Shigella dysenteriae type 1 or E. coli O157. The test utilizes methods like enzyme immunoassay (EIA), enzyme-linked immunosorbent assay (ELISA), fluorescence immunoassay (FIA), or immunochemiluminometric assay (IMCA) to detect the toxins.

2. Official Description

The official description of CPT code 87427 is: ‘Infectious agent antigen detection by immunoassay technique (eg, EIA, ELISA, FIA, IMCA), qualitative or semiquantitative; Shiga-like toxin.’

3. Procedure

1. The lab analyst performs an immunoassay technique on a primary source specimen, such as stool, obtained from the patient.
2. The analyst follows all technical steps to assess the presence of shiga-like toxins, such as SLT1 and SLT2, produced by organisms like E. coli O157.
3. The immunoassay technique may involve methods like EIA, ELISA, FIA, or IMCA.
4. The test detects the antigens or toxins associated with shiga-like toxins.
5. The lab analyst interprets the results of the immunoassay test to determine the presence or absence of shiga-like toxins.

4. Qualifying circumstances

CPT 87427 is used when there is a need to diagnose or rule out the presence of shiga-like toxins, which may indicate possible infection with E. coli O157 or Shigella dysenteriae type 1. Patients with infections caused by organisms producing shiga-like toxins may experience symptoms such as bloody diarrhea, vomiting, and abdominal cramps. In severe cases, the condition may progress to hemolytic uremic syndrome (HUS), which can lead to kidney failure and death. The test is performed on primary source specimens, such as stool, and should not be used for testing culture isolates.

5. When to use CPT code 87427

CPT code 87427 should be used when there is a clinical suspicion of infection with organisms that produce shiga-like toxins, such as E. coli O157 or Shigella dysenteriae type 1. It is appropriate to bill this code when the immunoassay technique is performed on a primary source specimen, such as stool, to detect the presence of shiga-like toxins. This code should not be used for testing culture isolates or for detecting antibodies to E. coli O157.

6. Documentation requirements

To support a claim for CPT code 87427, the documentation should include:

• Reason for ordering the test and clinical suspicion of infection with organisms producing shiga-like toxins
• Type of immunoassay technique used (EIA, ELISA, FIA, IMCA)
• Date of the test
• Results of the test indicating the presence or absence of shiga-like toxins
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT code 87427, ensure that the test is performed on a primary source specimen, such as stool, and that the immunoassay technique is used to detect shiga-like toxins. This code should not be reported for testing culture isolates. If the test is performed for different species or strains of the organism separately, each test should be reported with modifier 59. It is important to use the most specific code available when testing for E. coli O157 antigens or antibodies.

8. Historical information

CPT code 87427 was added to the Current Procedural Terminology system on January 1, 2001. There have been several updates to the code since its addition, including changes in the description and methodology.

9. Examples

1. A lab analyst performs an immunoassay technique on a stool specimen to detect shiga-like toxins produced by E. coli O157.
2. A patient presents with symptoms of bloody diarrhea, and a lab analyst performs an immunoassay test on a stool specimen to rule out the presence of shiga-like toxins.
3. A physician suspects an infection with Shigella dysenteriae type 1 in a patient, and a lab analyst performs an immunoassay technique on a stool specimen to detect the toxins.
4. A patient with suspected E. coli O157 infection provides a stool specimen, and a lab analyst performs an immunoassay test to confirm the presence of shiga-like toxins.
5. A lab analyst performs an immunoassay technique on a stool specimen from a patient with symptoms of hemolytic uremic syndrome to detect the presence of shiga-like toxins.
6. A physician orders an immunoassay test on a stool specimen to diagnose a possible infection with organisms producing shiga-like toxins.
7. A lab analyst performs an immunoassay technique on a stool specimen from a patient with suspected E. coli O157 infection to assess the presence of shiga-like toxins.
8. A patient presents with symptoms of abdominal cramps, and a lab analyst performs an immunoassay test on a stool specimen to detect the presence of shiga-like toxins.