How To Use CPT Code 87500

CPT 87500 describes the detection of vancomycin resistance in an infectious organism’s nucleic acid using an amplified 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 87500?

CPT 87500 can be used to report the performance of a nucleic acid detection test for vancomycin resistance in an infectious organism. This test specifically detects the presence of nucleic acid sequences associated with van A and van B genes, using an amplified probe technique. It is important to note that this code is used to report the detection of nucleic acid sequences responsible for resistance, not the organism itself.

2. Official Description

The official description of CPT code 87500 is: ‘Infectious agent detection by nucleic acid (DNA or RNA); vancomycin resistance (eg, enterococcus species van A, van B), amplified probe technique.’

3. Procedure

1. The lab analyst processes the specimen from a direct source, such as blood, feces, urine, or swabs.
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. The lab analyst assesses the presence of the amplified nucleic acid sequences that indicate the presence of the vancomycin resistant organism using a nucleic acid probe.
4. The nucleic acid probe, which is a fabricated single strand sequence of DNA or RNA, joins with the complementary sequence in the specimen through a process called hybridization.
5. The lab analyst visualizes the hybridization product using a label, such as a radioactive or chemical tag, attached to the nucleic acid probe.

4. Qualifying circumstances

CPT 87500 is typically ordered when a patient has an infection that is not responding to an antibiotic, particularly if enterococcus is causing the infection. Vancomycin-resistant enterococcus (VRE) is a common organism that shows vancomycin resistance. The test helps in the rapid detection of van A and van B genes, which can aid in providing the patient with the correct treatment quickly, thereby limiting the infection and possible consequences.

5. When to use CPT code 87500

CPT code 87500 should be used when performing a nucleic acid detection test for vancomycin resistance in a direct source specimen, such as urine or a rectal swab. It should not be used if the test is performed on a culture isolate. Additionally, it is important to note that some payers may separately reimburse for the collection of the specimen using a code such as 36415, which represents the collection of venous blood by venipuncture.

6. Documentation requirements

To support a claim for CPT 87500, the following documentation is required:

• Patient’s diagnosis and indication for the test
• Details of the specimen source
• Date of the test
• Specific nucleic acid sequences detected (van A, van B)
• Methodology used (amplified probe technique)
• Results of the test
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT 87500, ensure that the test is performed using an amplified probe technique to detect vancomycin resistance in the nucleic acid of an infectious organism. It is important to note that this code is intended for primary source specimens only, and should not be used for testing on culture isolates. Additionally, some payers may reimburse separately for the collection of the specimen using a different code. It is advisable to review payer-specific guidelines for accurate billing and reimbursement.

8. Historical information

CPT 87500 was added to the Current Procedural Terminology system on January 1, 2008. There have been no updates to the code since its addition.

9. Examples

1. A lab analyst performing a nucleic acid detection test for vancomycin resistance in a direct urine specimen.
2. A lab analyst using an amplified probe technique to detect van A and van B genes in a rectal swab specimen.
3. A patient with an infection that is not responding to antibiotics, requiring a nucleic acid detection test for vancomycin resistance in a blood specimen.
4. A lab analyst performing a nucleic acid detection test for vancomycin resistance in a feces specimen from a patient with suspected enterococcus infection.
5. A lab analyst using an amplified probe technique to detect van A and van B genes in a swab specimen from a wound infection.
6. A patient with a suspected vancomycin-resistant enterococcus infection, requiring a nucleic acid detection test using an amplified probe technique on a direct specimen.
7. A lab analyst performing a nucleic acid detection test for vancomycin resistance in a urine specimen from a patient with recurrent urinary tract infections.
8. A lab analyst using an amplified probe technique to detect van A and van B genes in a rectal swab specimen from a patient in a long-term care facility.
9. A patient with a suspected vancomycin-resistant enterococcus infection, requiring a nucleic acid detection test using an amplified probe technique on a direct specimen.
10. A lab analyst performing a nucleic acid detection test for vancomycin resistance in a blood specimen from a patient with a persistent infection.