cpt code 87591

(2022) CPT Code 87591 Description, Guidelines, Reimbursement, Modifiers & Examples

CPT code 87591 bills for service when a physician performs Infectious agent detection by nucleic acid (DNA or RNA), Neisseria gonorrhoeae, and amplified probe technique. Neisseria gonorrhea is one of the most widespread sexually transmitted infections. Molecular (nucleic acid probe) techniques offer rapid, accurate identification of Neisseria gonorrhea. This test may request gonorrhea amplified DNA probe, gonorrhea molecular probe assay, or DNA detection of gonorrhea.

CPT Code 87591 Description

The following are the reasons why the Physician performs CPT code 87591 to detect infections:

Chlamydia

Gonorrhea

Syphilis

Genital Herpes

Acquired Immune Deficiency Syndrome (AIDS)

Hepatitis B (HBV)

Genital Warts (HPV)

Trichomoniasis

Symptoms may include burning or itching in the penis or vagina, A drip (discharge) from the penis or vagina, pain around the pelvis, Sores, bumps or blisters on the penis or vagina, anus, or mouth, burning and pain with urine or with bowel movements, having to go to the bathroom often.

Amplification can perform using several techniques. While a cervical or urethral swab is preferred, molecular methods are sensitive enough to detect the organism in urine also. Neisseria gonorrhea can identify by DNA or rRNA probes. 

Ligase chain reaction (LCR) and Polymerase chain reaction (PCR)detect gonorrhea DNA. An Assay is also available, which detects gonorrhea ribosomal RNA (rRNA)

CPT code 87591 bills for service when Physician performs Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, amplified probe technique.

cpt 87591

CPT Code 87591 Reimbursement

A maximum of one unit can be a bill on the same service date of CPT code 87591. In contrast, the three units allow when documentation supports the medical necessity of the service.   

The cost of CPT 87591 is $42.84 when performed in the facility. In contrast, the reimbursement of 87591 with modifier 26 is $42.84 when performed in the non-facility. 

Investigative agent molecular diagnostic testing using nucleic acid probe reports with CPT codes 87471–87801 and 87901–87904. These CPT codes include all the molecular diagnostic processes. CPT codes 83890–83913 doses appropriate to report with these CPT codes.

CPT Code 87591 Modifiers  

The following are the list modifiers when CPT code 87591 bills:   

  • 22, 23, 52, 58, 59, 76, 77, 78, 79, 90, 91 AI, AQ, AR, CC, CR, ET, EY, FX, FY, GA, GC, GK, GR, GU, GY, GZ, KX, PT, Q5, Q6, QJ, SG, TC, XR, XP, XU, XS. 

Modifier 90 is applicable with CPT code 87591 when service performs by a party other than the treating or reporting Physician to repeat the same laboratory test on the same day to obtain subsequent (multiple) test results.

Modifier 91 is applicable with CPT 87591 when service performs by a Physician or other qualified health care professional. 

Modifier 76 is applicable with CPT code 87591 when a similar service performs by the Same Physician on the same day.   

Modifier 77 is applicable with CPT 87591 when a similar service performs by a different Physician on the same service date.  

Modifier 59 is applicable with CPT 87591 when a Distinct service performs by the Physician and bundles with another procedure on the same date.    

Modifier X {E, P, S, U} is applicable instead of Modifier 59 with 87591 when service bills to medicare insurance. It divides the modifier into four parts for further specification of the procedure.  

If physicians believe that Medicare will deny such service, reporting with a GA modifier is appropriate. The beneficiary must sign an Advance Beneficiary Notification (ABN), and 87591 must apply the GA modifier to that service.  

Modifier 52 is applicable when the Physician cannot complete the procedure due to unavoidable circumstances. 

CPT Code 87591 Billing Guidelines

Documentation should support the medical necessity of service. It reflects that service is medically necessary and appropriate.   

The following are the most used payable dx codes for CPT code 87591:

  • A54.23, A54.24, A54.29, A54.30, A54.00, A54.01, A54.02, A54.03, A54.09, A54.1, A54.21, A54.22, A54.31, A54.32, A54.33, A54.339, A54.40, A54.41, A54.42.

It is appropriate to report comparative tests on culture material (87140-87158) in conjunction with CPT code 87591. Check third party or payer guidelines if a modifier requires.

If identification antibodies (86602-86804) bills in combination with CPT 87591, it is appropriate to report. Check third party or payer guidelines if a modifier requires.

It is appropriate to report Nonspecific agent detection (87299, 87449, 87797-87799, 87899) in conjunction with CPT 87591. Check third party or payer guidelines if a modifier requires.

If Reporting molecular procedure codes as substitute for codes in this range (81109, 81110, 81111, 81161-81408, 81105, 81106, 81107, 81108, 81112, 81120, 81121, 81161, 81162, 81230, 81231, 81238, 81269, 81283, 81287, 81288, 81334)  bills combination with CPT 87591, it is appropriate to report. Check third party or payer guideline if modifier requires.

It is appropriate to modifier 59 with CPT code 87591 for additional specimens performed on the same day.

If any evaluation and management service (99201-99499) performs in addition to CPT 87591, It is appropriate to report separately.

Molecular pathology procedures (81200–81408) should not be reported in combination with, or instead of, the infection agent detection by nucleic acid procedures (87471–87801). Gonococcal infections with a duration of two months or more are considered chronic.

CPT Code 87591 Examples 

The following are the example when CPT code 87591 bills:

Example 1

A 25-year-old female presents with burning and itching in the vagina for seven days. She did not apply any medication to the itching site. She had sex with a stranger person eight days ago. 

The physical exam revealed swelling in the female genital organs. The Physician ordered an X-ray of the pelvis and labs test for gonorrhea infection.

 It shows no skin infections around the female genital organs. The patient denies any other symptoms such as headache, numbness, urinary problems, nausea, vomiting, and shortness of breath. 

The Physician advises the patient to take preventive action against infection in the future and prescribes medication. The lab test performed with the amplified probe technique reveals gonorrhea infection.

Example 2

A thirty-year-old female presents with pain during sexual intercourse. The patient developed an infection and took some medication for pain. 

The physical exam revealed swelling in the female genital organs. The Physician ordered an X-ray of the pelvis and labs test for gonorrhea infection.

 It shows no skin infections around the female genital organs. The patient denies any other symptoms such as headache, numbness, urinary problems, nausea, vomiting, and shortness of breath. 

The Physician advises the patient to take preventive action against infection in the future and prescribes medication. The lab test performed with the amplified probe technique reveals gonorrhea infection.

Example 3

A 25-year-old female presents with burning and itching in the penis for three days. She did not apply any medication to the itching site. She had sex with a stranger person two days ago.

The physical exam revealed swelling in the male genital organs. The Physician ordered an X-ray of the pelvis and labs test for gonorrhea infection.

 It shows no skin infections around the female genital organs. The patient denies any other symptoms such as headache, numbness, urinary problems, nausea, vomiting, and shortness of breath. 

The Physician advises the patient to take preventive action against infection in the future and prescribes medication. The lab test performed with the amplified probe technique reveals gonorrhea infection.

Example 4

A 27-year-old male presents with Sores, bumps, or blisters on the penis. The patient did not have any other symptoms and itching in the female genital area. 

The physical exam revealed swelling in the male genital organs. The Physician ordered an X-ray of the pelvis and labs test for gonorrhea infection.

 It shows no skin infections around the female genital organs. The patient denies any other symptoms such as headache, numbness, urinary problems, nausea, vomiting, and shortness of breath. 

The Physician advises the patient to take preventive action against infection in the future and prescribes medication. The lab test performed with the amplified probe technique reveals gonorrhea infection.

Example 5

A 29-year-old female presents with Sores, bumps, or blisters on the vagina for two weeks. She did not apply any medication to the itching site. She had sex with a stranger person 15 days ago. 

The physical exam revealed swelling in the female genital organs. The Physician ordered an X-ray of the pelvis and labs test for gonorrhea infection.

 It shows no skin infections around the female genital organs. The patient denies any other symptoms such as headache, numbness, urinary problems, nausea, vomiting, and shortness of breath. 

The Physician advises the patient to take preventive action against infection in the future and prescribes medication. The lab test performed with the amplified probe technique reveals gonorrhea infection.

Example 6

A 36-year-old female presents with pain with urine or bowel movements for two weeks. She did not take any medication for the problem. She had sex with a stranger person 15 days ago. 

The physical exam revealed swelling in the female genital organs. The Physician ordered an X-ray of the pelvis and labs test for gonorrhea infection.

 It shows no skin infections around the female genital organs. The patient denies any other symptoms such as headache, numbness, urinary problems, nausea, vomiting, and shortness of breath. 

The Physician advises the patient to take preventive action against infection in the future and prescribes medication. The lab test performed with the amplified probe technique reveals gonorrhea infection.

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