How To Use CPT Code 87803

CPT 87803 describes the process of detecting the presence of Clostridium difficile toxin A through an immunoassay with direct optical observation. This article will provide an overview of CPT code 87803, including its official description, the procedure involved, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 87803?

CPT 87803 is used to identify the presence of Clostridium difficile toxin A through an immunoassay with direct optical observation. This test is performed by a lab analyst who mixes a specimen, typically a stool sample, with a liquid reagent containing an antibody to Clostridium difficile toxin A. The analyst then dispenses the mixture onto a card that provides a visual result, indicating a positive or negative result for the presence of the toxin.

2. Official Description

The official description of CPT code 87803 is: ‘Infectious agent antigen detection by immunoassay with direct optical (i.e., visual) observation; Clostridium difficile toxin A.’

3. Procedure

1. The lab analyst receives a specimen, typically a stool sample, for testing.
2. The analyst mixes the specimen with a liquid reagent containing an antibody to Clostridium difficile toxin A.
3. A time interval is allowed for the antibody-antigen reaction to occur.
4. The analyst dispenses the mixture onto a card that provides a visual result.
5. A positive result may be indicated by a color change or the appearance of a line on the card.
6. The analyst interprets the visual result to determine the presence or absence of Clostridium difficile toxin A.

4. Qualifying circumstances

CPT 87803 is typically ordered when a patient presents with prolonged, serious diarrhea, especially if mucus or blood is present. It is not limited to testing for a specific condition but is commonly used to detect the presence of Clostridium difficile toxin A, which causes colitis, also known as pseudomembranous colitis. This infection is often healthcare-associated and can occur after a patient has taken antibiotics for another illness.

5. When to use CPT code 87803

CPT code 87803 should be used when there is a need to detect the presence of Clostridium difficile toxin A through an immunoassay with direct optical observation. It is appropriate to use this code when a lab analyst performs the test and provides a visual result indicating the presence or absence of the toxin. This code should not be used for other tests related to Clostridium difficile detection, such as immunoassay technique, tissue culture, or nucleic acid testing.

6. Documentation requirements

To support a claim for CPT code 87803, the following documentation is required:

• Patient’s symptoms and indication for the test
• Details of the specimen used for testing
• Description of the immunoassay technique and direct optical observation
• Date and time of the test
• Interpretation of the visual result
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT code 87803, ensure that the test is performed by a lab analyst using the immunoassay technique with direct optical observation. It is important to follow the specific guidelines provided by payers regarding the reporting of this code. It is also essential to consider any additional codes that may be necessary for specimen collection or other related services.

8. Historical information

CPT code 87803 was added to the Current Procedural Terminology system on January 1, 2002. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient with prolonged, serious diarrhea presents with mucus and blood. CPT code 87803 is used to detect the presence of Clostridium difficile toxin A through an immunoassay with direct optical observation.
2. A healthcare provider suspects a Clostridium difficile infection in a patient who recently completed a course of antibiotics. CPT code 87803 is used to confirm the presence or absence of Clostridium difficile toxin A.
3. A patient with symptoms of colitis undergoes testing to determine if Clostridium difficile toxin A is present. CPT code 87803 is used to perform the immunoassay with direct optical observation.
4. A lab analyst receives a stool sample from a patient with suspected Clostridium difficile infection. CPT code 87803 is used to detect the presence of Clostridium difficile toxin A through the immunoassay technique.
5. A patient with persistent diarrhea is tested for the presence of Clostridium difficile toxin A using CPT code 87803. The lab analyst performs the immunoassay with direct optical observation to provide a visual result.