How To Use CPT Code 87798

CPT 87798 is a code used for detecting infectious agents by nucleic acid (DNA or RNA) through an amplified probe technique. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 87798.

1. What is CPT 87798?

CPT 87798 is a code used in medical billing and coding to represent a laboratory test performed for detecting infectious agents not specified in another code using nucleic acid (DNA or RNA) and an amplified probe technique. This code is utilized when the laboratory technique is known to be an amplified probe technique, but a specific code for the infectious agent is not available. The test is typically ordered by healthcare providers when they are looking for a rare cause of infection or when testing for common organisms has returned negative results.

2. 87798 CPT code description

The official description of CPT code 87798 is: “Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; amplified probe technique, each organism.”

3. Procedure

1. The lab analyst collects a specimen from a direct source, such as blood.
2. The specimen is processed using amplification techniques, such as polymerase chain reaction (PCR), resulting in a significant increase in the number of copies of a specific target nucleic acid sequence.
3. The lab analyst assesses the presence of the amplified nucleic acid sequences, indicating the presence of an infectious agent not specified in another code 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 nucleic acid probe includes a label, such as a radioactive or chemical tag, that allows the lab analyst to visualize the hybridization product.

4. Qualifying circumstances

Patients eligible to receive CPT 87798 services are those who require testing for an infectious agent not specified in another code and when the laboratory technique is known to be an amplified probe technique. This test may be ordered by healthcare providers when they are looking for a rare cause of infection or when testing for common organisms has returned negative results.

5. When to use CPT code 87798

It is appropriate to bill the 87798 CPT code when a healthcare provider orders a test for detecting an infectious agent not specified in another code using an amplified nucleic acid probe technique. This code should be used if the laboratory technique is known to be an amplified probe technique, but a specific code for the infectious agent is not available. The test is typically ordered when looking for a rare cause of infection or when testing for common organisms has returned negative results.

6. Documentation requirements

To support a claim for CPT 87798, the following information should be documented:

• Patient’s medical history and reason for the test
• Ordering healthcare provider’s information
• Specimen collection date and time
• Specimen type and source
• Amplification technique used
• Nucleic acid probe information, including the label used
• Test results and interpretation
• Any additional relevant clinical information

7. Billing guidelines

When billing for CPT code 87798, it is essential to follow specific guidelines and rules. If testing for more than one not otherwise specified (NOS) organism, a modifier such as 59 (Distinct procedural service) may be required to indicate that multiple tests were performed. Some payers may pay separately for collecting the specimen using a code such as 36415 for venipuncture. It is crucial to ensure that all documentation requirements are met to support the claim for CPT 87798.

8. Historical information

CPT 87798 was added to the Current Procedural Terminology system on January 1, 1998. The code was changed on January 1, 2001, with the previous descriptor being “Infectious agent detection by nucleic acid (DNA or RNA); not otherwise specified, amplified probe technique.”

9. Similar codes to CPT 87798

Five similar codes to CPT 87798 and how they differentiate are:

• CPT 87797: This code is used for detecting infectious agents by nucleic acid (DNA or RNA) through a direct probe technique, rather than an amplified probe technique.
• CPT 87799: This code is used for detecting infectious agents by nucleic acid (DNA or RNA) through a quantification technique, rather than an amplified probe technique.
• CPT 87800: This code is used for detecting multiple infectious agents by nucleic acid (DNA or RNA) through a multiplex probe technique, rather than an amplified probe technique.
• CPT 87801: This code is used for detecting multiple infectious agents by nucleic acid (DNA or RNA) through a multiplex reverse transcription and amplified probe technique, rather than a single amplified probe technique.
• CPT 87802: This code is used for detecting a specific infectious agent, such as HIV, by nucleic acid (DNA or RNA) through an amplified probe technique, rather than a not otherwise specified infectious agent.

10. Examples

Here are 10 detailed examples of CPT code 87798 procedures:

1. A patient with a wound infection after surgery tests negative for common organisms, and the healthcare provider orders a test for Vibrio metschnikovii detection by nucleic acid, amplified probe technique.
2. A patient with a persistent fever of unknown origin undergoes testing for a rare infectious agent using an amplified probe technique.
3. A patient with a suspected rare respiratory infection has a test performed using an amplified nucleic acid probe technique to identify the causative organism.
4. A patient with a history of recurrent infections and negative results for common organisms undergoes testing for a rare infectious agent using an amplified probe technique.
5. A patient with an unexplained skin rash has a test performed using an amplified nucleic acid probe technique to identify a possible rare infectious agent.
6. A patient with a suspected rare gastrointestinal infection undergoes testing using an amplified nucleic acid probe technique to identify the causative organism.
7. A patient with a history of travel to a region with endemic rare infections undergoes testing for a rare infectious agent using an amplified probe technique.
8. A patient with a suspected rare central nervous system infection has a test performed using an amplified nucleic acid probe technique to identify the causative organism.
9. A patient with a suspected rare bloodstream infection undergoes testing using an amplified nucleic acid probe technique to identify the causative organism.
10. A patient with a suspected rare ocular infection has a test performed using an amplified nucleic acid probe technique to identify the causative organism.