How To Use CPT Code 87511

CPT 87511 describes the detection of Gardnerella vaginalis, a bacterium that commonly causes bacterial vaginosis, using an amplified 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 87511?

CPT 87511 can be used to detect the presence of Gardnerella vaginalis, a bacterium that is often responsible for bacterial vaginosis. This code specifically refers to the use of an amplified nucleic acid probe technique to identify the presence of the bacterium in a patient’s specimen.

2. Official Description

The official description of CPT code 87511 is: ‘Infectious agent detection by nucleic acid (DNA or RNA); Gardnerella vaginalis, amplified probe technique.’

3. Procedure

1. The lab analyst processes the patient’s specimen, which can include vaginal discharge, urethral swabs, or urine.
2. Amplification techniques, such as polymerase chain reaction (PCR), are used to increase the number of copies of the 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 assesses the presence of the amplified nucleic acid sequences that indicate the presence of Gardnerella vaginalis using a labeled nucleic acid probe.
5. The presence of Gardnerella vaginalis is visualized through the hybridization product.

4. Qualifying circumstances

CPT 87511 is used when there is a need to detect the presence of Gardnerella vaginalis in patients experiencing symptoms such as odorous vaginal discharge or vaginal discomfort. The test is typically ordered by clinicians to diagnose infection with Gardnerella vaginalis. It is important to note that this test is not limited to a specific condition and can be used for both male and female patients.

5. When to use CPT code 87511

CPT code 87511 should be used when there is a need to detect the presence of Gardnerella vaginalis using an amplified nucleic acid probe technique. It is important to ensure that the test is medically necessary and ordered by a qualified healthcare professional.

6. Documentation requirements

To support a claim for CPT 87511, the following documentation is required:

• Indication of the need for the test, such as symptoms or suspected infection
• Details of the specimen used for testing
• Explanation of the amplification techniques used
• Description of the hybridization process and visualization of the presence of Gardnerella vaginalis
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT 87511, ensure that the test is performed using an amplified nucleic acid probe technique to detect Gardnerella vaginalis. It is important to follow the specific guidelines provided by the payer and use the appropriate modifiers if necessary. It is also important to distinguish CPT codes 87510, 87511, and 87512 for direct probe, amplified probe, and quantification tests for Gardnerella vaginalis, respectively.

8. Historical information

CPT 87511 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 patient presents with odorous vaginal discharge, and the clinician orders CPT 87511 to detect the presence of Gardnerella vaginalis.
2. A male patient is asymptomatic but has a sexual partner diagnosed with Gardnerella vaginalis infection. The clinician orders CPT 87511 to determine if the patient is also infected.
3. A female patient experiences vaginal discomfort and undergoes CPT 87511 to diagnose a possible Gardnerella vaginalis infection.
4. A patient with recurrent bacterial vaginosis symptoms undergoes CPT 87511 to confirm the presence of Gardnerella vaginalis.
5. A pregnant patient with a history of Gardnerella vaginalis infection undergoes CPT 87511 as part of routine prenatal care.
6. A male patient presents with urethral discharge, and CPT 87511 is ordered to detect the presence of Gardnerella vaginalis.
7. A female patient with a history of Gardnerella vaginalis infection undergoes CPT 87511 to monitor the effectiveness of treatment.
8. A patient with persistent vaginal discomfort undergoes CPT 87511 to rule out Gardnerella vaginalis infection.
9. A male patient with no symptoms undergoes CPT 87511 as part of a comprehensive sexually transmitted infection screening.
10. A female patient with recurrent urinary tract infections undergoes CPT 87511 to determine if Gardnerella vaginalis is a contributing factor.