How To Use CPT Code 87497

CPT 87497 describes the quantification of infection with cytomegalovirus (CMV) using nucleic acid probe 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 87497?

CPT 87497 can be used to quantify the presence of cytomegalovirus (CMV) infection using nucleic acid probe technique. This code is used when a lab analyst performs a test to evaluate the amount of CMV in a specimen obtained from a direct source such as blood, body fluids, or tissue. The test involves amplification techniques, such as polymerase chain reaction (PCR), to increase the number of copies of a specific target nucleic acid sequence. The lab analyst then uses a nucleic acid probe to visualize and quantify the hybridization product, indicating the presence of CMV.

2. Official Description

The official description of CPT code 87497 is: ‘Infectious agent detection by nucleic acid (DNA or RNA); cytomegalovirus, quantification.’

3. Procedure

1. The lab analyst processes the specimen obtained from a direct source, such as blood, body fluids, or tissue.
2. Amplification techniques, such as polymerase chain reaction (PCR), are performed to increase the number of copies of a specific target nucleic acid sequence.
3. A nucleic acid probe, which is a fabricated single strand sequence of DNA or RNA, is used to join with the complementary sequence in the specimen through a process called hybridization.
4. The lab analyst visualizes and quantifies the hybridization product using a label, such as a radioactive or chemical tag, attached to the nucleic acid probe.
5. The amount of nucleic acids related to cytomegalovirus (CMV) is quantified, allowing clinicians to evaluate the patient’s response to treatment.

4. Qualifying circumstances

CPT 87497 is used to quantify the presence of cytomegalovirus (CMV) infection. This test is typically ordered by clinicians to diagnose CMV infection, which can cause severe illness in newborns and immunocompromised patients. The test is performed on specimens obtained from a direct source, such as blood, body fluids, or tissue. It is important to note that CPT 87497 is specifically for quantification and should not be confused with other codes for direct probe or amplified probe tests for CMV.

5. When to use CPT code 87497

CPT code 87497 should be used when there is a need to quantify the amount of cytomegalovirus (CMV) in a specimen obtained from a direct source, such as blood, body fluids, or tissue. This code is appropriate when the lab analyst performs nucleic acid probe technique to visualize and quantify the hybridization product, indicating the presence of CMV. It is important to use this code specifically for quantification and not for other types of CMV tests.

6. Documentation requirements

To support a claim for CPT code 87497, the following documentation is required:

• Specimen source (blood, body fluids, tissue)
• Details of the amplification techniques used, such as polymerase chain reaction (PCR)
• Description of the nucleic acid probe technique and hybridization process
• Quantification of the amount of nucleic acids related to cytomegalovirus (CMV)
• Label used for visualization and quantification of the hybridization product
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT code 87497, ensure that the test is performed to quantify the presence of cytomegalovirus (CMV) using nucleic acid probe technique. It is important to distinguish this code from other codes for direct probe or amplified probe tests for CMV. Additionally, consider any specific guidelines provided by payers for specimen collection, such as using a separate code for venipuncture. It is also important to note that CPT code 87497 should not be reported with codes for CMV antibody detection tests.

8. Historical information

CPT code 87497 was added to the Current Procedural Terminology system on January 1, 1998. There have been no updates to the code since its addition.

9. Examples

1. A lab analyst quantifying the amount of cytomegalovirus (CMV) in a blood specimen obtained from a newborn with suspected CMV infection.
2. A lab analyst performing nucleic acid probe technique to quantify the presence of cytomegalovirus (CMV) in a tissue specimen from an immunocompromised patient.
3. A lab analyst using polymerase chain reaction (PCR) to amplify the nucleic acid sequences of cytomegalovirus (CMV) in a body fluid specimen, followed by quantification using a nucleic acid probe technique.
4. A lab analyst visualizing and quantifying the hybridization product of cytomegalovirus (CMV) in a blood specimen obtained from a patient undergoing treatment for CMV infection.
5. A lab analyst performing nucleic acid probe technique to quantify the amount of cytomegalovirus (CMV) in a tissue specimen from a patient with suspected CMV-related complications.