How To Use CPT Code 87506

CPT 87506 describes the detection of gastrointestinal pathogens using nucleic acid analysis. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 87506?

CPT 87506 can be used to detect six to eleven types or subtypes of gastrointestinal pathogens, such as Clostridium difficile, E. coli, Salmonella, Shigella, norovirus, and Giardia. This code involves the use of nucleic acid analysis, including multiplex reverse transcription and multiplex amplified probe technique, to identify and quantify the presence of these pathogens.

2. Official Description

The official description of CPT code 87506 is: ‘Infectious agent detection by nucleic acid (DNA or RNA); gastrointestinal pathogen (eg, Clostridium difficile, E. coli, Salmonella, Shigella, norovirus, Giardia), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 6-11 targets.’

3. Procedure

1. The lab analyst performs nucleic acid analysis to detect six to eleven types or subtypes of gastrointestinal pathogens.
2. This analysis includes multiplex reverse transcription, which copies a nucleotide sequence from an RNA template during DNA synthesis, and multiplex amplified probe technique, which quickly provides large numbers of target DNA copies using polymerase chain reaction (PCR).
3. The lab analyst evaluates the amplified product and quantifies the number of microorganisms present.

4. Qualifying circumstances

CPT 87506 is used when there is a need to detect six to eleven types or subtypes of gastrointestinal pathogens. This test is ordered by providers to identify the presence of specific pathogens, such as Clostridium difficile, E. coli, Salmonella, Shigella, norovirus, and Giardia, that cause gastrointestinal infections.

5. When to use CPT code 87506

CPT code 87506 should be used when there is a need to detect six to eleven types or subtypes of gastrointestinal pathogens using nucleic acid analysis. It is appropriate to use this code when the specific pathogens being tested for are within this range. If the test involves three to five types or subtypes, CPT code 87505 should be used. For 12 to 25 types or subtypes, CPT code 87507 is more appropriate.

6. Documentation requirements

To support a claim for CPT 87506, the following documentation is required:

• Indication of the need for gastrointestinal pathogen detection
• Specific types or subtypes of pathogens being tested for
• Date and time of the test
• Results of the nucleic acid analysis, including the quantification of microorganisms present

7. Billing guidelines

When billing for CPT 87506, ensure that the test is performed to detect six to eleven types or subtypes of gastrointestinal pathogens using nucleic acid analysis. It is important to note that if reverse transcription is performed during the analysis, it should not be billed separately. Additionally, for tests involving three to five types or subtypes, CPT code 87505 should be used, and for 12 to 25 types or subtypes, CPT code 87507 is more appropriate.

8. Historical information

CPT 87506 was added to the Current Procedural Terminology system on January 1, 2015. There have been no updates to the code since its addition.

9. Examples

1. A lab analyst performs nucleic acid analysis to detect the presence of Clostridium difficile, E. coli, Salmonella, Shigella, norovirus, and Giardia in a patient’s gastrointestinal sample.
2. Nucleic acid analysis is used to identify and quantify the presence of six to eleven types or subtypes of gastrointestinal pathogens in a patient with symptoms of a gastrointestinal infection.
3. A provider orders CPT 87506 to detect the presence of specific gastrointestinal pathogens in a patient who has recently traveled to a region known for outbreaks of these pathogens.
4. A lab analyst performs nucleic acid analysis to detect the presence of gastrointestinal pathogens in a patient with persistent diarrhea and abdominal pain.
5. CPT 87506 is used to identify and quantify the presence of Clostridium difficile, E. coli, Salmonella, Shigella, norovirus, and Giardia in a patient with suspected food poisoning.
6. A provider orders CPT 87506 to detect the presence of specific gastrointestinal pathogens in a patient with a compromised immune system.
7. Nucleic acid analysis is performed to identify and quantify the presence of six to eleven types or subtypes of gastrointestinal pathogens in a patient with symptoms of a gastrointestinal illness.
8. A lab analyst uses multiplex reverse transcription and multiplex amplified probe technique to detect the presence of Clostridium difficile, E. coli, Salmonella, Shigella, norovirus, and Giardia in a patient’s gastrointestinal sample.
9. CPT 87506 is used to identify and quantify the presence of specific gastrointestinal pathogens in a patient with recurrent episodes of gastrointestinal infections.
10. A provider orders CPT 87506 to detect the presence of specific gastrointestinal pathogens in a patient with symptoms of a foodborne illness.