How To Use CPT Code 87498

CPT 87498 describes the detection of enterovirus using nucleic acid amplification and 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 87498?

CPT 87498 is used to detect the presence of enterovirus in a patient’s specimen using nucleic acid amplification and probe technique. This test is commonly performed on samples such as cerebrospinal fluid or throat swabs to provide a definitive diagnosis of meningitis. The amplified probe technique allows for the rapid identification of microorganisms, making it faster than traditional culture methods. If reverse transcription is performed during the test, it is also included in this code. This test may also be referred to as enterovirus by polymerase chain reaction.

2. Official Description

The official description of CPT code 87498 is: ‘Infectious agent detection by nucleic acid (DNA or RNA); enterovirus, amplified probe technique, includes reverse transcription when performed.’

3. Procedure

1. A patient specimen, such as cerebrospinal fluid or a throat swab, is collected for testing.
2. The laboratory performs nucleic acid amplification and probe technique on the specimen to detect the presence of enterovirus.
3. If necessary, reverse transcription is performed during the test to copy a nucleotide sequence from an RNA template during DNA synthesis.
4. The test results are analyzed to determine the presence or absence of enterovirus in the specimen.
5. A definitive diagnosis of meningitis or other enterovirus-related conditions can be made based on the test results.

4. Qualifying circumstances

CPT 87498 is used when a laboratory performs nucleic acid amplification and probe technique to detect enterovirus in a patient’s specimen. This test is typically ordered when there is a suspicion of meningitis or other enterovirus-related conditions. The specimen can include cerebrospinal fluid or throat swabs. If reverse transcription is performed during the test, it is also included in this code.

5. When to use CPT code 87498

CPT code 87498 should be used when a laboratory performs nucleic acid amplification and probe technique to detect enterovirus in a patient’s specimen. This code is appropriate when there is a clinical suspicion of meningitis or other enterovirus-related conditions. It is important to ensure that the test is performed using the specific technique described in the code.

6. Documentation requirements

To support a claim for CPT code 87498, the laboratory must document the following information:

• Patient’s clinical indication for the test
• Type of specimen collected for testing
• Date and time of the test
• Details of the nucleic acid amplification and probe technique performed
• Results of the test and interpretation
• Signature of the laboratory personnel performing the test

7. Billing guidelines

When billing for CPT code 87498, ensure that the laboratory has performed nucleic acid amplification and probe technique to detect enterovirus in the patient’s specimen. If reverse transcription is also performed during the test, it should be included in this code. It is important to follow the specific guidelines provided by the payer regarding the appropriate use of this code and any additional documentation requirements.

8. Historical information

CPT code 87498 was added to the Current Procedural Terminology system on January 1, 2007. There have been two changes to the code since its addition. On January 1, 2013, the code description was revised to specify that it includes amplified probe technique. On January 1, 2014, the code description was further revised to include reverse transcription when performed.

9. Examples

1. A laboratory performs nucleic acid amplification and probe technique on a patient’s cerebrospinal fluid to detect the presence of enterovirus, providing a definitive diagnosis of meningitis.
2. A throat swab specimen is tested using nucleic acid amplification and probe technique to identify the presence of enterovirus in a patient with suspected enterovirus-related symptoms.
3. A laboratory performs reverse transcription during the nucleic acid amplification and probe technique to detect enterovirus in a patient’s specimen, aiding in the diagnosis of an enterovirus infection.