How To Use CPT Code 87561

CPT 87561 describes the detection of Mycobacterium avium intracellulare (MAI) 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 87561?

CPT 87561 can be used to detect the presence of Mycobacterium avium intracellulare (MAI) using an amplified nucleic acid probe technique. This code is used when the lab analyst performs a test for MAI by processing a specimen from a direct source, such as blood, sputum, or swab, and using amplification techniques, such as polymerase chain reaction (PCR), to assess the presence of amplified nucleic acid sequences that indicate the presence of MAI. The lab analyst uses a nucleic acid probe, which is a fabricated single strand sequence of DNA or RNA, to join with the complementary sequence in the specimen through a process called hybridization. The presence of MAI is visualized through the hybridization product.

2. Official Description

The official description of CPT code 87561 is: ‘Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria avium-intracellulare, amplified probe technique.’

3. Procedure

1. The lab analyst processes the specimen from a direct source, such as blood, sputum, or swab.
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 amplified nucleic acid sequences that indicate the presence of Mycobacterium avium intracellulare (MAI) using a nucleic acid probe.
4. The nucleic acid probe, 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 to determine the presence of MAI.

4. Qualifying circumstances

CPT 87561 is used for the detection of Mycobacterium avium intracellulare (MAI) using an amplified nucleic acid probe technique. MAI most commonly causes pulmonary infections in immunocompromised patients but can also cause joint inflammation, systemic infections, and other conditions. This code is used when the lab analyst performs the test on a specimen from a direct source, such as blood, sputum, or swab, and uses amplification techniques, such as polymerase chain reaction (PCR), to assess the presence of MAI.

5. When to use CPT code 87561

CPT code 87561 should be used when there is a need to detect the presence of Mycobacterium avium intracellulare (MAI) using an amplified nucleic acid probe technique. This code is appropriate when the lab analyst performs the test on a specimen from a direct source, such as blood, sputum, or swab, and uses amplification techniques, such as polymerase chain reaction (PCR), to assess the presence of MAI. It is important to note that this code is not limited to testing for a specific condition but is commonly used for pulmonary infections in immunocompromised patients.

6. Documentation requirements

To support a claim for CPT 87561, the following documentation is required:

• Specimen source (blood, sputum, swab, etc.)
• Details of the amplification techniques used, such as polymerase chain reaction (PCR)
• Assessment of the presence of amplified nucleic acid sequences indicating the presence of Mycobacterium avium intracellulare (MAI)
• Documentation of the nucleic acid probe used for hybridization
• Visualization of the hybridization product
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT 87561, ensure that the test is performed using an amplified nucleic acid probe technique to detect Mycobacterium avium intracellulare (MAI). It is important to distinguish between direct probe, amplified probe, and quantification tests for MAI (CPT codes 87560, 87561, and 87562, respectively). Additionally, consider any specific guidelines provided by payers regarding specimen collection, and ensure accurate reporting of the test performed.

8. Historical information

CPT 87561 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 performs an amplified nucleic acid probe test for Mycobacterium avium intracellulare (MAI) on a blood specimen from an immunocompromised patient.
2. A sputum sample is processed by a lab analyst using polymerase chain reaction (PCR) to detect the presence of Mycobacterium avium intracellulare (MAI) using an amplified nucleic acid probe technique.
3. A lab analyst assesses the presence of amplified nucleic acid sequences indicating the presence of Mycobacterium avium intracellulare (MAI) in a swab specimen using a nucleic acid probe and hybridization.
4. The hybridization product is visualized by a lab analyst to determine the presence of Mycobacterium avium intracellulare (MAI) in a specimen obtained from a direct source.